Departement Of Cardiothoracic And Vascular Surgery, Cardiac Surgery Unit, A.O.U. Sassari, Sassari, Italy.
Departement Of Cardiothoracic And Vascular Surgery, Cardiac Anesthesiology Unit, A.O.U. Sassari, Sassari, Italy.
J Cardiothorac Surg. 2024 May 7;19(1):281. doi: 10.1186/s13019-024-02779-8.
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.
在二尖瓣手术过程中损伤冠状动脉是一种罕见但危及生命的手术并发症，左回旋支（LCx）的异常起源和走行增加了这种风险。通过特征性的血管造影模式识别这种异常，并使用成像技术（主要是经食管超声心动图（TOE）或冠状动脉计算机断层血管造影（CCTA））识别其与周围解剖结构的关系，对于制定最佳手术策略至关重要。我们报告了一例回旋支（LCx）起源于右冠状动脉（RCA）近端的病例，其走行经主动脉后通过二尖瓣-主动脉间隙。通过多学科团队（包括心脏病专家和影像学放射科医生）使用综合诊断方法，我们能够决定手术策略。我们成功地使用微创小开胸术和植入完全半刚性环的方法进行了二尖瓣瓣膜修复。
