Mitral Valve Repair in a Case with Anomalous Origin of the Left Circumflex Artery

Abstract

Anomalous origin of the left circumflex coronary artery is considered benign and asymptomatic in most cases. However, some cases with complication have been reported during aortic valve and mitral valve surgery due to their anatomical location. We report a case of mitral valve repair for mitral valve prolapse with anomalous origin of the left circumflex coronary artery. A 59-year-old woman presented with weight gain and dyspnea. Echocardiography revealed a mitral valve prolapse due to A1 chordal rupture, and we planned a mitral valve repair. Preoperative coronary computed tomography angiography showed anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva, running through the aortomitral curtain. To avoid ischemic events in the left circumflex artery, we chose a band instead of a ring for annuloplasty. In addition, we performed reconstruction with artificial chordae tendineae to A1, consequently postoperative echocardiography showed no valve regurgitation. Postoperative coronary computed tomography angiography showed a sufficient gap between the left circumflex coronary artery and the annuloplasty band. If we chose a ring for annuloplasty, significant interference with the left circumflex artery would likely have occurred.