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

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Presentation transcript:

Circumflex artery injury during mitral valve repair: Not well known, perhaps not so infrequent—lessons learned from a 6-case experience Gonçalo F. Coutinho, MD, PhD, Filipe Leite, MD, Manuel J. Antunes, MD, PhD, DSc The Journal of Thoracic and Cardiovascular Surgery Volume 154, Issue 5, Pages 1613-1620 (November 2017) DOI: 10.1016/j.jtcvs.2017.05.043 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Coronary angiogram in case 1 revealing total occlusion of the circumflex artery. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Immediate postoperative coronary angiogram in case 2, revealing a 90% occlusion of the CxA (arrow). B, Result after stent implantation. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Coronary angiogram in case 3 revealing an “elbow-like” distortion of the CxA, with incomplete occlusion of the vessel (arrow). B, Angiogram performed 1 month after the surgery, showing no lesions. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Immediate postoperative coronary angiogram performed in case 4, showing a subtotal occlusion of the CxA (arrow). B, Angiogram performed 1 month after discharge revealed a 50% lesion of the CxA involving the origin of the first obtuse marginal artery. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Coronary angiogram performed in case 5, showing a 50% to 75% lesion of the distal CxA (arrow). B, Result after balloon dilation (arrow). The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 A, Immediate postoperative coronary angiogram performed in case 6, showing total occlusion of the CxA (arrow). B, Angiogram performed during hospitalization, revealing full patency of the CxA and the saphenous venous graft. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Color Doppler of the CxA. Large asterisk shows strong echodense wall of the CxA, and small asterisk shows weak echodense wall of the coronary sinus. LA, Left atrium; LAD, left anterior descending artery; left main, left main coronary artery. From Ender et al.24 The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

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. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 1613-1620DOI: (10.1016/j.jtcvs.2017.05.043) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions