Percutaneous Coronary Intervention for Iatrogenic Occlusion of the Circumflex Artery After Mitral Anuloplasty

Mantilla, Ramón; Legarra, Juan José; Pradas, Gonzalo; Bravo, Marisol; Sanmartı́n, Marcelo; Goicolea, Javier

doi:10.1016/s1885-5857(06)60296-x

Cited by 15 publications

(25 citation statements)

References 5 publications

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“…The surrounding tissue and/or the adventitia had been grasped by one of the ring sutures attracting the vessel leading to a plication restricting blood flow. In this case report, a guidewire could easily be passed through the occluded artery and an angioplasty with stenting was performed with an excellent angiographic result [3]. The early postsurgical administration of high dose antiplatelet therapy as required by the use of the metallic stent did not raise any difficulty.…”

Section: Case Reportmentioning

confidence: 85%

“…Iatrogenic injury to the circumflex coronary artery following mitral annuloplasty has only been reported on rare occasions (11 published cases to date [1][2][3][4][5][6][7][8][9] including this report) but we believe that this event has been underrated. Early diagnosis of this complication can be difficult and its management still raises controversies [6][7][8].…”

Section: Introductionmentioning

confidence: 82%

See 1 more Smart Citation

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Aubert¹,

Barthélémy²,

Landi³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Iatrogenic injury to the circumflex coronary artery following mitral annuloplasty is a potentially fatal complication. It can be clinically silent or else be responsible for a cardiogenic shock. The diagnosis should be suspected on EKG changes with segmental dysfunction of the lateral wall on the intraoperative echography. The author reports one case whose recognition relied on emergency angiography; the patient was successfully treated by angioplasty and stenting. The management of this complication remains controversial and the various treatment modalities are discussed.

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Section: Case Reportmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 82%

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Aubert¹,

Barthélémy²,

Landi³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Using a PubMed search, we identified 44 cases of mitral valve repair/replacement associated myocardial ischemia (Table ) . Since no large registries exist and previous reports disagree regarding possible risk factors, symptoms, diagnostic signs, and available therapeutic strategies, we performed a comprehensive analysis summarizing current knowledge based on all available cases.…”

Section: Discussionmentioning

confidence: 99%

Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature

Hiltrop

Bennett

Desmet

2016

Cathet Cardio Intervent

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As the LCx is closely related to the mitral valve annulus, it is susceptible to perioperative injury. Various underlying mechanisms, predisposing factors, and therapeutic strategies have been suggested but disagreement exists. Using a MeSH terms-based PubMed search, 44 cases of mitral valve surgery-related LCx injury were detected, including our 4 cases. We provide a comprehensive review of current knowledge regarding mitral valve surgery-related left circumflex coronary artery (LCx) injury. Preoperative coronary angiography was performed in 55% (n = 24). Coronary abnormalities were present in 11% (n = 5). Coronary dominance was reported in 73% (n = 32), predominantly showing left (69%, n = 22) or balanced (19%, n = 6) circulations. Right coronary dominance was present in 12% (n = 4). Ischemia was detected in the perioperative or early postoperative phase in 86% (n = 30). Delayed symptoms were present in 14% (n = 5). Echocardiography demonstrated new regional wall motion abnormalities in 80% (n = 24), but was negative in 20% (n = 6) despite coronary compromise. Electrocardiography showed myocardial ischemia in 97% (n = 34), including regional ST-segment elevations in 68% (n = 23). Primary treatment was surgical in 42% (n = 15) and percutaneous in 58% (n = 21), reporting success ratios of 87% (n = 13) and 81% (n = 17), respectively. We confirm an augmented risk of mitral valve surgery-related LCx injury in balanced or left-dominant coronary circulations. Preoperative knowledge of coronary anatomy does not preclude LCx injury. An anomalous LCx arising from the right coronary cusp was identified as a possible specific high-risk entity. Electrocardiographic monitoring and intraoperative echocardiography remain paramount to ensure a timely diagnosis and treatment. © 2016 Wiley Periodicals, Inc.

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“…Most common appears to be tissue distortion and kinking of the artery, but sometimes there is no clear explanation for the injury. 5,13,15,[19][20][21][22] Careful placement of the sutures, 1 or 1.5 mm behind the hinge of the annulus, and the needle oriented toward the ventricle will probably help to avoid this complication, but crimping of the annulus, rather than the sutures themselves may be the causative mechanism.…”

Section: Mechanisms Of Circumflex Artery Injurymentioning

confidence: 99%

Circumflex artery injury during mitral valve repair: Not well known, perhaps not so infrequent—lessons learned from a 6-case experience

Coutinho

Leite

Antunes

2017

The Journal of Thoracic and Cardiovascular Surgery

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The close spacial relationship between the circumflex artery and the mitral annulus. Reprinted with permission from: Carpentier A, Adams DH, Filsoufi F. Carpentier's Reconstructive Valve Surgery. Philadelphia, PA: Saunders; 2010. Central Message Circumflex artery injury during MV surgery is most likely under-recognized and underreported. Prompt diagnosis and treatment are associated with the most favorable outcomes.

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Percutaneous Coronary Intervention for Iatrogenic Occlusion of the Circumflex Artery After Mitral Anuloplasty

Cited by 15 publications

References 5 publications

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Circumflex coronary artery injury following mitral annuloplasty treated by emergency angioplasty

Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature

Circumflex artery injury during mitral valve repair: Not well known, perhaps not so infrequent—lessons learned from a 6-case experience

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