Surgical management of a patient with anomalous origin of the left circumflex coronary artery undergoing aortic and mitral valve surgery

TL;DR

A rare coronary artery anomaly was managed during aortic and mitral valve surgery, requiring special surgical techniques to avoid damage.

Contribution

This case highlights the importance of identifying and addressing anomalous coronary arteries during complex valve surgeries.

Findings

Anomalous left circumflex coronary artery can complicate aortic and mitral valve surgery.

Preemptive coronary artery bypass grafting is a viable solution in such cases.

The patient had successful surgery with no ischemic damage and was discharged in stable condition.

Abstract

The anomalous origin of the left circumflex coronary artery is rare and, when isolated, typically has minimal pathological significance. However, it can cause damage or compression of the coronary artery during aortic and mitral valve surgery.

The patient was a 34-year-old male diagnosed with severe aortic regurgitation due to a bicuspid aortic valve following infective endocarditis at the mitral valve. He was referred to our hospital owing to worsening heart failure. Preoperative evaluation revealed a mitral valve aneurysm and an anomalous left circumflex coronary artery originating from the right coronary artery and running posteriorly along the aortic valve annulus. During surgery, dissection of the anomalous left circumflex coronary artery was challenging. Mitral valve aneurysm repair and aortic valve replacement were performed. For the aortic valve replacement, a 23-mm St. Jude Medical Regent valve, one size smaller than optimal, was secured in the supra-annular position. Additionally, a coronary artery bypass graft was performed on the distal circumflex artery using a saphenous vein graft. The patient experienced no ischemic myocardial damage and was discharged in stable condition on postoperative day 14.

The anomalous origin of the left circumflex coronary artery should be recognized, and appropriate measures must be taken during valve surgery. Preemptive coronary artery bypass grafting is a reasonable option for patients undergoing aortic and mitral valve surgeries.

The online version contains supplementary material available at 10.1186/s44215-025-00215-4.

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