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Iatrogenic Left Circumflex Coronary Artery Fistula after Mitral Valve Replacement.

ABSTRACT: Highlights•LCx injury during MV surgery occurs at a frequency of about 1%.•Injury typically occurs in the proximal vessel near the MV anterolateral commissure.•Echocardiography is important in diagnosing and assessing coronary artery fistulas.

SUBMITTER: Gentry JL

PROVIDER: S-EPMC6200676 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Left circumflex artery injury following surgical mitral valve replacement: a case report.

Project description:BackgroundMitral valve (MV) repair or replacement surgery is indicated for a variety of conditions. Although uncommon, damage to the left circumflex (LCx) coronary artery, which courses in close proximity to the MV annulus, is a devastating complication.Case summaryThis report describes the case of a 63-year-old woman following re-operative MV replacement. Shortly after being transferred to the surgical intensive care unit after MV replacement, her EKG was notable for persistent inferolateral ST-segment elevations and reciprocal ST-segment depressions. Emergency transthoracic echocardiogram revealed a reduced left ventricular ejection fraction of 35-40% and mid to distal lateral wall motion hypokinesis. She was emergently taken to the cardiac catheterization laboratory where coronary angiography demonstrated complete occlusion of her mid LCx artery. She underwent urgent percutaneous coronary intervention of the lesion and was started on dual antiplatelet treatment, anticoagulation for comorbid atrial fibrillation, as well as guideline directed medical therapy with improvement in her EKG changes and cardiac function.ConclusionPrompt diagnosis and recognition of LCx injury is crucial. Management involves immediate percutaneous recanalization or surgical coronary bypass grafting.

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Aorto - Left atrial fistula after mitral valve replacement.

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Phasic disappearance of left circumflex coronary artery from an early complication of mitral valve surgery.

Project description:LV pseudoaneurysm can be a late complication of mitral valve replacement. In our case, it was an early postoperative complication. This pseudoaneurysm was causing compression of LCX artery during systole, leading to presentation of NSTEMI two weeks after the surgery.

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Anomalous left circumflex artery: Implications for valve-sparing root replacement.

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Postoperative coronary artery spasm after mitral valve replacement.

Project description:INTRODUCTION:Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease PRESENTATION OF CASE:We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. DISCUSSION:A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. CONCLUSION:This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery.

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Coronary Cameral Fistula from Left Circumflex Artery to Left Atrium Identified by Three-Dimensional Transesophageal Echocardiography.

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A rare cause of mitral regurgitation after aortic valve replacement: Iatrogenic mitral valve perforation.

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Iatrogenic mitral stenosis following transcatheter aortic valve replacement (TAVR).

Project description:A 57 year old female underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Mild iatrogenic mitral stenosis was noted intraoperatively. Attempts to reposition the device were hampered by aortic angulation. One year later, severe mitral stenosis was confirmed on transoesophageal echocardiography. It is important to recognise that iatorgenic mitral stenosis due to TAVR may progress over time. Care should be taken to minimise the risk of this rare complication.

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Transcatheter Closure of Complex Left Circumflex to Coronary Sinus Fistula.

Project description:Coronary artery fistulae connecting the left circumflex to the coronary sinus are rare. Surgical closure of coronary sinus connections is technically challenging because of the location, especially in high-risk surgical patients. We used multimodality imaging to delineate the drainage site and successfully closed a left circumflex to coronary sinus fistula using a transcatheter closure technique. (Level of Difficulty: Advanced.).

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