Mitral Valve Repair and Anomalous Origin of Circumflex Artery

Figure 1. 3D Preoperative Echocardiogram Preoperative 3-dimensional echocardiography showing prolapse of the P2 scallop of the mitral valve. AV = aortic valve; MR = mitral regurgitation; PV = pulmonary valve; TV = tricuspid valve.

Figure 2. Preoperative Angiogram Preoperative angiography showing the anomaly origin and course of the circumflex artery. LCX = left circumflex coronary artery; RCA = right coronary artery.

Figure 3. Preoperative Cardiac Computed Tomography Scan Preoperative cardiac computed tomography showing the retro-aortic course of the circumflex artery. On the left, 3-dimensional reconstruction of the computed tomography images on the right. LA = left atrium; other abbreviations as in Figure 2.

Central Illustration. Schematic of the Left Circumflex Coronary Artery Schematic of the left circumflex coronary artery anomalous aortic origin and course during mitral valve repair with a complete prosthetic ring compared to normal course (upper left box). RCS = right coronary sinus.

Figure 4. Postoperative Angiogram Postoperative angiography showing a mitral prosthetic ring in place occluding the mid-portion of the circumflex artery (small black arrow). ECMO = extracorporeal membrane oxygenator; IVC = inferior vena cava; LCX = left circumflex artery; MV = mitral valve.