Severance of mitral prosthesis fixation sutures by annulus calcification

Danielson, Gordon K.; Cooper, Eric; Ifuku, Masumi

doi:10.1016/s0022-5223(19)43139-5

Cited by 18 publications

(2 citation statements)

References 9 publications

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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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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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“…LCX artery injury can transform low risk single valve surgery into higher double open-heart surgeries or emergency need for percutaneous coronary intervention (PCI) after cardiac surgery [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]. Sporadic cases of this complication have been reported in the literature [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]. Anatomical studies on the LCX artery proposed the left-dominant coronary circulation to be a risk factor due to the shortest distance recorded between the LCX artery and MV [26], [33], [34], [35].…”

Section: Introductionmentioning

confidence: 99%

Left circumflex artery injury postmitral valve surgery, single center experience

Husain

Alsanei

Tahir

et al. 2019

Journal of the Saudi Heart Association

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The left circumflex (LCX) artery is located close to the mitral valve (MV), making it susceptible to injury during MV surgery. We are reporting our experience in the diagnosis and management of this complication. We retrospectively reviewed our surgical and coronary angiography databases for patients with documented LCX artery injury during MV surgery between January 2000 and December 2016. The complication was associated with MV replacement (9/1313, 0.7%) but not MV repair (0/393, 0.0%). Eight patients (88.9%) were female and the mean age was 40.4 ± 14.2 years. There was roughly similar distribution of left and right dominant coronary circulations (5 and 4 patients, respectively). Eight patients (88.9%) had ischemic changes on electrocardiogram and ventricular arrhythmias were documented on six patients (66.7%). Three patients (33.3%) were treated with percutaneous coronary intervention while six patients (66.7%) required redo surgery to graft the LCX artery. The 30-day mortality was high (33.3%). A high index of suspicion is required to diagnose this injury. At the moment, no consensus is available on the optimal treatment strategy. We propose percutaneous approach as the first option to spare the patients from undergoing open-heart surgery for the second time.

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