Husain Aysha, Alsanei Aly, Tahir Mohammed, Dahdouh Ziad, AlHalees Zohair, AlMasood Ali
Heart Center, King Faisal Hospital and Research Center, Riyadh Saudi Arabia.
J Saudi Heart Assoc. 2019 Apr;31(2):94-99. doi: 10.1016/j.jsha.2018.12.003. Epub 2018 Dec 31.
The left circumflex (LCX) artery is located close to the mitral valve (MV), making it susceptible to injury during MV surgery. We are reporting our experience in the diagnosis and management of this complication. We retrospectively reviewed our surgical and coronary angiography databases for patients with documented LCX artery injury during MV surgery between January 2000 and December 2016. The complication was associated with MV replacement (9/1313, 0.7%) but not MV repair (0/393, 0.0%). Eight patients (88.9%) were female and the mean age was 40.4 ± 14.2 years. There was roughly similar distribution of left and right dominant coronary circulations (5 and 4 patients, respectively). Eight patients (88.9%) had ischemic changes on electrocardiogram and ventricular arrhythmias were documented on six patients (66.7%). Three patients (33.3%) were treated with percutaneous coronary intervention while six patients (66.7%) required redo surgery to graft the LCX artery. The 30-day mortality was high (33.3%). A high index of suspicion is required to diagnose this injury. At the moment, no consensus is available on the optimal treatment strategy. We propose percutaneous approach as the first option to spare the patients from undergoing open-heart surgery for the second time.
左旋支（LCX）动脉靠近二尖瓣（MV），在MV手术期间易受损伤。我们报告我们在该并发症诊断和处理方面的经验。我们回顾性分析了2000年1月至2016年12月期间MV手术中记录有LCX动脉损伤患者的手术和冠状动脉造影数据库。该并发症与MV置换相关（9/1313，0.7%），但与MV修复无关（0/393，0.0%）。8例患者（88.9%）为女性，平均年龄为40.4±14.2岁。左右优势冠状动脉循环分布大致相似（分别为5例和4例患者）。8例患者（88.9%）心电图有缺血改变，6例患者（66.7%）记录有室性心律失常。3例患者（33.3%）接受了经皮冠状动脉介入治疗，6例患者（66.7%）需要再次手术以移植LCX动脉。30天死亡率较高（33.3%）。诊断这种损伤需要高度的怀疑指数。目前，关于最佳治疗策略尚无共识。我们建议将经皮方法作为首选，以使患者避免再次接受心脏直视手术。
