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.
Aortic Valve , Coronary Vessel Anomalies , Echocardiography, Transesophageal , Mitral Valve , Humans , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Mitral Valve/abnormalities , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve/abnormalities , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/diagnostic imaging , Coronary Angiography , Computed Tomography Angiography , Male , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Female , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging
Abnormalities, Multiple/diagnosis , Echocardiography, Transesophageal/methods , Heart Defects, Congenital/diagnosis , Heart Septal Defects, Ventricular/diagnosis , Heart Ventricles/abnormalities , Magnetic Resonance Imaging, Cine/methods , Adult , Female , Humans , Multimodal Imaging/methods , Rare Diseases
