Percutaneous coronary intervention of an iatrogenic occlusion of the circumflex coronary artery after mitral valve replacement

Dello, Simon Awg; Leus, Stefan; Tan, Mengwei; Otterspoor, Luuk C.; Botman, Cornelis J.

doi:10.1177/2048872615623066

Cited by 6 publications

(9 citation statements)

References 3 publications

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“…Primary PCI was tried in most cases. Some cases described in literature showed good results with successful angioplasty, 7 - 9 while other cases were complicated by coronary perforation or premature stent restenosis or transferred to operating room for surgical intervention after failed percutaneous intervention. 10 , 11 A conservative approach was adopted in minority of cases where the artery was of small caliber in absence of hemodynamic or electrical instability.…”

Section: Discussionmentioning

confidence: 99%

Left circumflex coronary artery injury following mitral valve replacement with late presentation: A case report and literature review

Nassereddine

Kazem

Moussa

et al. 2022

J Cardiovasc Thorac Res

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Mitral valve replacement complications are more and more recognized due to the novel surgical techniques and the tendency to report such complications by young cardiologists and surgeons. Circumflex coronary artery injury is a rare complication that occurs during mitral valve replacement or repair by multiple mechanisms. We present the case of a 57-year-old female who underwent mitral valve replacement and ended up with heart failure after circumflex artery occlusion and failure of percutaneous coronary intervention.

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Section: Discussionmentioning

confidence: 99%

Left circumflex coronary artery injury following mitral valve replacement with late presentation: A case report and literature review

Nassereddine

Kazem

Moussa

et al. 2022

J Cardiovasc Thorac Res

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“… 9 However, when the vessel is obstructed by an encircling suture, CABG or repositioning of the prosthesis are reasonable alternatives. 10 …”

Section: Discussionmentioning

confidence: 99%

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

Kaneko

Kochar

Sung

et al. 2021

European Heart Journal - Case Reports

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Background Mitral 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 summary This 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. Conclusion Prompt diagnosis and recognition of LCx injury is crucial. Management involves immediate percutaneous recanalization or surgical coronary bypass grafting.

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“…The documented incidence of CX injury secondary to MV surgery varies between 0.15% and 4.0% [ 1 , 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 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], but various authors suggest that the true incidence is probably significantly higher due to underreporting. Danielson and colleagues [ 1 ] were the first to document 3 patients with CX injury in their series of 178 MV procedures in 1967, followed by Roberts [ 2 ], Morin [ 3 ], Virmani [ ...…”

Section: Current Circumflex Coronary Artery Injury Prevention Diagnos...mentioning

confidence: 99%

“…The intraoperative diagnosis of CX injury is currently documented in 20 reports of 34 patients [ 6 , 10 , 11 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 22 , 28 , 31 , 35 , 39 , 40 , 41 , 42 , 45 , 46 ] and suggests that only 48.3% of all documented CX injuries during MV surgery are diagnosed intraoperatively. Once suspected, urgent confirmation of CX injury and the rapid identification of the responsible mechanism by TEE and/or coronary angiography are crucial to expedite the appropriate treatment strategy [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 <...…”

Section: Current Circumflex Coronary Artery Injury Prevention Diagnos...mentioning

confidence: 99%

“…Myocardial infarction secondary to circumflex coronary artery (CX) distortion or occlusion during mitral valve (MV) surgery is associated with devastating postoperative morbidity and mortality outcomes [ 1 , 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 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Despite significant improvements in preoperative risk identification [ 50 , 51 , 52 , 53 , 54 ...…”

Section: Introductionmentioning

confidence: 99%

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Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

Merwe¹,

Casselman

2023

Medicina

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The devastating impact of a circumflex coronary artery (CX) injury during mitral valve (MV) surgery is well reported. Despite significant improvements in preoperative risk assessment, intraoperative diagnosis and perioperative treatment strategies of CX injury during MV surgery, recent reports re-emphasize the variability in presentation, the unpredictable mechanisms of injury and the conflicting evidence regarding perioperative management. The progressive transition from conventional sternotomy access to minimally invasive surgical and transcatheter (TC) interventions for MV disease are associated with significant learning curves and require additional single-shaft and robotic console suture manipulation skills with special attentiveness to the potential risk of CX injury. The introduction of hybrid theatres that facilitate single stage surgical and TC interventions also provides new intraoperative diagnostic and therapeutic options without transporting unstable patients for percutaneous coronary intervention (PCI) assessment. By utilizing a MeSH terms-based PubMed search, a total of 89 patients with CX injury that occurred during MV surgery was identified from 49 reports between 1967 and 2022. MV surgery was performed by conventional sternotomy (n = 76, 85.4%), endoscopic (n = 12, 13.4%) and robotic access (n = 1, 1.1%), with 35 injuries (39.3%) resulting in total CX occlusion. Rescue PCI was utilized in 40 patients (44.9%). This manuscript provides a systematic overview of all available historic and contemporary reports on CX injury during MV surgery, outlines recent refinements in CX injury mechanisms, describes current MV surgery associated CX injury prevention and diagnosis and treatment strategies and highlights important MV procedural aspects that may minimize the risk and consequences of CX injury.

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Percutaneous coronary intervention of an iatrogenic occlusion of the circumflex coronary artery after mitral valve replacement

Cited by 6 publications

References 3 publications

Left circumflex coronary artery injury following mitral valve replacement with late presentation: A case report and literature review

Left circumflex coronary artery injury following mitral valve replacement with late presentation: A case report and literature review

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

Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

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