Iatrogenic circumflex coronary artery injury after mitral valve replacement

Left circumflex coronary artery injury following mitral valve replacement with late presentation: A case report and literature review

“…Some cases described in literature showed good results with successful angioplasty, 7 - 9 while other cases were complicated by coronary perforation or premature stent restenosis or transferred to operating room for surgical intervention after failed percutaneous intervention. 10 , 11 A conservative approach was adopted in minority of cases where the artery was of small caliber in absence of hemodynamic or electrical instability. Surgical revision was done when coronary ischemia was suspected before chest closure or in some instable patients in immediate postoperative period.…”

Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

“…The documented incidence of CX injury secondary to MV surgery varies between 0.15% and 4.0% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], but various authors suggest that the true incidence is probably significantly higher due to underreporting. Danielson and colleagues [ 1 ] were the first to document 3 patients with CX injury in their series of 178 MV procedures in 1967, followed by Roberts [ 2 ], Morin [ 3 ], Virmani [ ...…”

“…Once suspected, urgent confirmation of CX injury and the rapid identification of the responsible mechanism by TEE and/or coronary angiography are crucial to expedite the appropriate treatment strategy [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Flow-limiting CX injuries diagnosed intraoperatively require emergency revascularization and restoration of distal perfusion by either emergency empiric coronary artery bypass grafting (CABG) of the obtuse marginal branches utilizing saphenous vein [ 6 , 10 , 14 , 15 , 19 , 27 , 31 , 37 , 38 , 48 ], by revising the prosthesis sutures [ ...…”

“…The detrimental impact of CX injury during MV surgery on mortality and subsequent quality of life in survivors is well described [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Bargagna and colleagues [ 48 ] re-emphasized that the true incidence of CX injury is most likely underreported due to unawareness of CX injury in clinically stable patients, publication bias and unrecognized clinical features.…”

“…Myocardial infarction secondary to circumflex coronary artery (CX) distortion or occlusion during mitral valve (MV) surgery is associated with devastating postoperative morbidity and mortality outcomes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Despite significant improvements in preoperative risk identification [ 50 , 51 , 52 , 53 , 54 ...…”