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

1 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 (November 2017) DOI: /j.jtcvs Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

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

3 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

4 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

5 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

6 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

7 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

8 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

9 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  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

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