Author + information
- Received February 6, 2012
- Revision received June 14, 2012
- Accepted June 21, 2012
- Published online November 1, 2012.
- Carrie Eshelbrenner, MD and
- S. Hinan Ahmed, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. S. Hinan Ahmed, Division of Cardiology, Internal Medicine, University of Texas Health Sciences Center, 7703 Floyd Curl Drive, MSC 7872, San Antonio, Texas 78229
The incidence of anomalous coronary arteries is ∼1%, with heterogeneous clinical outcomes (1). Left circumflex coronary artery (LCX) entrapment is an infrequently reported complication of mitral valve surgery and correlates to the dominance and the distance of the artery from the mitral annulus. Nearly all reported cases present intraoperatively or immediately post-operatively (2). Our patient presented 14 years following mitral valve annuloplasty with long-standing chest pain and dyspnea on exertion. Myocardial perfusion imaging showed a large area of inferolateral ischemia. Computed tomography angiography revealed an anomalous right coronary artery (RCA) arising from the left cusp and coursing between the great arteries with a narrowed proximal segment. It also showed a severe focal stenosis of the LCX with traction of the artery toward the mitral valve, suggestive of an iatrogenic entrapment (Fig. 1).
Cardiac catheterization confirmed the anomalous origin of the RCA and the high-grade stenosis of mid LCX (Fig. 2). The LCX intravascular ultrasound imaging revealed a very fibrotic, high-grade stenosis of the mid vessel. This lesion was treated with serial low-pressure balloon inflations using a compliant balloon. Stent implantation was performed using a 4.5 × 15-mm bare-metal stent (Vision, Abbott Vascular, Abbott Park, Illinois) followed by post-dilation with a noncompliant balloon. The patient continues to be completely symptom free at 6-month follow-up.
It is an unusual case of these 2 abnormalities occurring in the same patient with a late presentation, albeit with long-standing symptoms. In the literature, management of both conditions is largely anecdotal, and percutaneous coronary intervention is infrequently used.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 6, 2012.
- Revision received June 14, 2012.
- Accepted June 21, 2012.
- American College of Cardiology Foundation