Clinical case report of circumflex artery occlusion after repair of the bicuspid aortic valve
Abstract
The article presents
a clinical case of complication of bicuspid aortic valve repair. The patient
underwent external annuloplasty and plication of the aortic valve leaflets
through ministernotomy. After the completion of the main stage of the
intervention, the restoration of cardiac activity and departure to the
intensive care unit, the patient developed signs of myocardial infarction. It
was decided to perform an emergency coronary angiography, during which an
occlusion of the circumflex artery was detected, which was not passable by the
conductor. In the operating room, the annululasty strip in the projection of
the left coronary artery was dismantled with good hemodynamic and clinical
results. The presented clinical case indicates the need to pay special attention
to the variant anatomy of the coronary arteries, which is often observed in
patients with bicuspid aortic valve. It is possible to avoid such complications
by performing preoperative coronary angiography in all patients planning
bicuspid aortic valve repair.
Keywords:case report; bicuspid aortic valve; aortic regurgitation; minimally invasive cardiac surgery
Funding. The research was carried out within the support of
the grant of the Russian Federation President No. 075-15-2022-823.
Conflict of interest. The authors declare no conflict of interest.
For citation: Karadzha A.V., Sharifulin R.M., Pivkin A.N.,
Bogachev-Prokophiev A.V. Clinical case report of circumflex artery occlusion
after repair of the bicuspid aortic valve. Clinical and Experimental Surgery.
Petrovsky Journal. 2022; 10 (4): 67–72. DOI: https://doi.org/10.33029/2308-1198-2022-10-4-67-72
(in Russian)
References
1. Arnaoutakis G.J., Sultan I., Siki M., Bavaria J.E. Bicuspid aortic valve repair: systematic review on long-term outcomes. Ann Cardiothorac Surg. 2019; 8 (3): 302–12. DOI: https://doi.org/10.21037/acs.2019.05.08 PMID: 31240174; PMCID: PMC6562085.
2. Safari M., Monsefi N., Karimian-Tabrizi A., Miskovic A., Van Linden A., Zacek P., et al. Longer-term outcomes after bicuspid aortic valve repair in 142 patients. J Card Surg. 2021; 36 (12): 4645–51. DOI: https://doi.org/10.1111/jocs.16006 Epub 2021 Sep 21. PMID: 34547142.
3. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J., et al.; ESC/EACTS Scientific Document Group, ESC National Cardiac Societies. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022; 43 (7): 561–632. DOI: https://doi.org/10.1093/eurheartj/ehab395
4. Sharifulin R.M., Demin I.I., Astapov D.A., Afanas’ev A.V., Pivkin A.N., Ovcharov M.A., et al. Aortic root reconstruction in bicuspid aortic valve. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2020; 13 (3): 213–23. DOI: https://doi.org/10.17116/kardio202013031213 (in Russian)
5. Ehrlich T., de Kerchove L., Vojacek J., Boodhwani M., El-Hamamsy I., De Paulis R., et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis. 2020; 63 (4): 457–64. DOI: https://doi.org/10.1016/j.pcad.2020.04.010
6. Lansac E., Di Centa I., Sleilaty G., Lejeune S., Khelil N., Berrebi A., et al. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg. 2016; 50 (2): 350–60. DOI: https://doi.org/10.1093/ejcts/ezw070 PMID: 27440158.
7. DeFaria Yeh D. Coronary artery variants and bicuspid aortic valve disease: gaining insight into genetic underpinnings. Heart. 2018; 104 (5): 363–4. DOI: https://doi.org/10.1136/heartjnl-2017-311634 Epub 2017 Sep 27. PMID: 28954834.