# Anomalous circumflex artery encircling the aortic annulus: implications for mitral valve repair

## TL;DR

A rare case of an anomalous left circumflex artery is reported, highlighting the importance of imaging in planning safe mitral valve repair.

## Contribution

The paper presents a novel case of anomalous LCx anatomy and demonstrates a successful surgical strategy using a multidisciplinary imaging approach.

## Key findings

- Anomalous LCx originated from the proximal RCA and ran retroaortically through the mitro-aortic space.
- Integrated diagnostic imaging allowed safe surgical planning and successful mitral valve repair.
- Minimally invasive techniques were used with a semirigid ring implantation.

## Abstract

Injury to coronary arteries during mitral surgery is a rare but life-threatening procedural complication, an anomalous origin and course of the left circumflex artery (LCx) increase this risk. Recognizing the anomaly by the characteristic angiographic pattern and identifying its relationship with the surrounding anatomical structure using imaging techniques, mainly transesophageal echocardiography (TOE) or coronary computed tomography angiography (CCTA), is of crucial importance in setting up the best surgical strategy. We report a case of anomalous origin of a circumflex artery (LCx) from the proximal portion of the right coronary artery (RCA) with a pathway running retroaortically through the mitro-aortic space. An integrated diagnostic approach using a multidisciplinary team with a cardiologist and an imaging radiologist allowed us to decide the surgical strategy. We successfully performed a mitral valvular repair using a minimally invasive minithoracotomic approach and implanting a complete semirigid ring.