Surgeons must be aware of the altered anatomy in patients with corrected transposition and ASD to avoid iatrogenic injury to the circumflex coronary artery during mitral valve surgery.
May warrant preoperative coronary mapping in corrected transposition before mitral surgery; extends sparse case reports but leaves open efficacy of routine safeguards.
In spite of the knowledge gained from earlier reports about injury to the circumflex coronary artery, we have encountered such lethal damage in a case of corrected transposition with mitral insufficiency and an atrial septal defect. Due to the abnormal anatomy of the heart, the circumflex artery was injured 10 cm from its origin by one of the sutures for the annuloplasty performed through the atrial septal defect. In all other described cases, the artery has been injured 2.5 to 3 cm from its origin. The delayed onset of symptoms may be due to the comparatively distal injury to the circumflex coronary artery in the case of corrected transposition resulting in smaller infarction. In the second case, with mitral valve replacement at re-operation for mitral insufficiency in a case of primum defect of the atrial septum with cleft mitral valve, the injury to the circumflex coronary artery by one stitch was detected. The stitch was replaced more superficially and the patient made an uneventful recovery.
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Björk et al. (1972) studied this question.
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