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April 3, 2026Japanese Journal of Cardiovascular Surgery0 citationsOpen Access

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

YOYuki OhtomoYOYurie OhtomoTKTadashi Kitamura

Key Result

Mitral valve repair using an annuloplasty band instead of a ring successfully avoided ischemic events in a patient with mitral valve prolapse and an anomalous origin of the left circumflex artery.

Key Points

  • This case focuses on the surgical approach to mitral valve repair when there is an anomalous origin of the left circumflex artery.
  • Patient underwent echocardiography for diagnosis of mitral valve prolapse and chordal rupture.
  • Coronary artery evaluation assessed the anomalous origin of the left circumflex artery.
  • A band was chosen for valve annulus formation to avoid interference with the left circumflex artery.
  • Successful reconstruction of the anterior mitral leaflet using artificial chordae was achieved.
  • Post-operative echocardiography showed no evidence of mitral regurgitation.
  • The distance between the band and left circumflex artery was confirmed safe, which could have been compromised with a ring.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does using an annuloplasty band instead of a ring prevent ischemic events during mitral valve repair in a patient with anomalous origin of the left circumflex coronary artery?

P
Population
59-year-old woman with mitral valve prolapse (A1 chordal rupture) and anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva.
I
Intervention
Mitral valve repair using an annuloplasty band (SimuPlus Band 28 mm) and artificial chordae tendineae to A1, with specific suture placement at the hinge of the leaflet to avoid left circumflex artery compression.
O
Outcome
Avoidance of ischemic events in the left circumflex artery and successful mitral valve repair without regurgitation.safety

Using an annuloplasty band instead of a full ring during mitral valve repair in patients with an anomalous left circumflex artery can safely prevent iatrogenic coronary compression and ischemia.

Abstract

左回旋枝の起始異常は，冠動脈起始異常の中でも良性とされており無症状のままで経過する場合がほとんどであるが，大動脈弁および僧帽弁の手術を行う際，その解剖学的な位置関係から支障をきたすことが報告されている．今回われわれは，左回旋枝起始異常を伴った僧帽弁逸脱症に対して僧帽弁形成術を施行した1例を経験したので文献的考察を加えて報告する．59歳女性，息切れと体重増加を主訴に当院循環器内科を受診した．心エコー検査でa1の腱索断裂による僧帽弁逸脱症と診断され，僧帽弁形成術を施行する方針となった．術前の冠動脈評価にて左回旋枝が右バルサルバ洞から起始し，僧帽弁前尖側の弁輪に沿って走行している異常が認められたことから，弁輪形成については左回旋枝への干渉を避けるためにリングではなくバンドを選択した．a1に一対の人工腱索を再建し，術後の心エコーでは弁逆流の消失を認めた．冠動脈ctaにてバンドと左回旋枝との距離は離れていることが確認できるが，もし弁輪形成にリングを選択していた場合には，左回旋枝に大きく干渉していた可能性がある．今後僧帽弁手術において同様の起始異常が認められた際には，本報告が左回旋枝の虚血イベントを回避し，安全に弁形成を行う上で参考になり得ると考える．

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Cite This Study

Ohtomo et al. (2026) conducted a case report in Mitral valve prolapse with anomalous origin of the left circumflex coronary artery (n=1). Mitral valve repair with annuloplasty band was evaluated on Valve regurgitation and ischemic events. Mitral valve repair using an annuloplasty band instead of a ring successfully avoided ischemic events in a patient with mitral valve prolapse and an anomalous origin of the left circumflex artery.

synapsesocial.com/papers/69cf5e2e5a333a821460c447https://doi.org/10.4326/jjcvs.55.65
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