Compression of an anomalous left circumflex coronary artery by a bioprosthetic valve ring.

The most common anomaly of the coronary arteries is the origin of the left circumflex artery from the right sinus of Valsalva or the right coronary artery proper. This anomaly is rarely clinically significant. A patient is reported here who has such an anomaly which did become clinically significant after a bioprosthetic aortic valve replacement. The circumflex artery described here became compressed between the Hancock aortic valvular ring and the mitral valvular apparatus. This case is the first antemortem report of such a compression to be demonstrated angiographically and the first case to be the results of an aortic bioprosthetic ring alone. Special surgical considerations must be made when performing valvular replacements on patients with this coronary artery anomaly.