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Late Presentation of Recurrent Monomorphic Ventricular Tachycardia following Minimally Invasive Mitral Valve Repair due to Epicardial Injury

DOI: 10.1155/2014/976494

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We report a 73-year-old male with late onset monomorphic ventricular tachycardia following mitral valve repair (MVR). Typically, injury to epicardial arteries following mitral valve repair/replacement presents immediately as ventricular tachycardia/fibrillation, difficulty weaning from cardiopulmonary bypass, worsening ECG changes, increasing cardiac biomarkers, or new wall motion abnormalities. Our case illustrates a “late complication” of a distorted circumflex artery following mitral valve repair and the importance of early diagnostic angiography and percutaneous intervention. 1. Introduction In experienced centers mitral valve repair has low mortality rates and excellent outcomes. The Cleveland Clinic and Mayo Clinic report 30 day mortality rates of 0.3% and 0.9%, respectively [1, 2]. Injury to the circumflex artery during MVR is a recognized complication, albeit rare. The proximity of the circumflex artery to the anterolateral commissure of the mitral valve predisposes the artery to injury during mitral valve surgery [3, 4]. Acute occlusion of the circumflex artery may manifest immediately as ventricular arrhythmia, difficulty weaning from cardiopulmonary bypass, ST elevation myocardial infarction, or new wall motion abnormality [5]. We report a late onset sustained monomorphic ventricular tachycardia (SMVT) secondary to distortion of the circumflex artery following mitral valve repair. 2. Case Report A 73-year-old male with mitral regurgitation presented to his primary cardiologist with symptoms of increasing dyspnea on exertion. As part of the diagnostic workup, a transthoracic echocardiogram (TTE) was performed which revealed significant pulmonary hypertension (estimated pulmonary artery pressures of 50–55?mmHg), not previously seen on prior TTE. Moderate mitral valve insufficiency with prolapse of the posterior leaflet and normal right ventricular function was also present. Past medical history was significant for hyperlipidemia, chronic obstructive pulmonary disease, chronic kidney disease (stage 3), and benign prostatic hypertrophy. The decision was made by the primary cardiologist to refer the patient for mitral valve repair. In anticipation of the aforementioned procedure a left and right cardiac catheterization was performed which showed a left dominant system with nonobstructive coronary artery disease, normal left ventricular function, right ventricular pressures of 68/9?mmHg, pulmonary artery pressures of 63/30?mmHg, and a pulmonary capillary wedge pressure of 21?mmHg. The patient was then referred for cardiothoracic surgeon


[1]  R. M. Suri, H. V. Schaff, J. A. Dearani et al., “Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era,” Annals of Thoracic Surgery, vol. 82, no. 3, pp. 819–826, 2006.
[2]  A. M. Gillinov, D. M. Cosgrove, E. H. Blackstone et al., “Durability of mitral valve repair for degenerative disease,” Journal of Thoracic and Cardiovascular Surgery, vol. 116, no. 5, pp. 734–743, 1998.
[3]  A. M. Grande, A. Fiore, M. Massetti, and M. Viganò, “Iatrogenic circumflex coronary lesion in mitral valve surgery: case report and review of the literature,” Texas Heart Institute Journal, vol. 35, no. 2, pp. 179–183, 2008.
[4]  C. J. N. Pessa, W. J. Gomes, R. Catani, J. C. Prates, and E. Buffolo, “Anatomical relashionship between the posterior mitral valve annulus and the coronary arteries. Implications to operative treatment,” Brazilian Journal of Cardiovascular Surgery, vol. 19, pp. 372–377, 2004.
[5]  N. Patel, F. Cuculi, and A. P. Banning, “Two rings too tight: sequential emergency PCI for hemodynamic and arrhythmic complications of mitral and tricuspid valve repair,” Catheterization and Cardiovascular Interventions, vol. 83, no. 1, pp. E73–E76, 2013.
[6]  R. Virmani, P. K. C. Chun, J. Parker, and H. A. McAllister Jr., “Suture obliteration of the circumflex coronary artery in three patients undergoing mitral valve operation. Role of left dominant or codominant coronary artery,” Journal of Thoracic and Cardiovascular Surgery, vol. 84, no. 5, pp. 773–778, 1982.
[7]  T. Aybek, P. Risteski, A. Miskovic et al., “Seven years' experience with suture annuloplasty for mitral valve repair,” Journal of Thoracic and Cardiovascular Surgery, vol. 131, no. 1, pp. 99–106, 2006.
[8]  N. N. Somekh, A. Haider, A. N. Makaryus, S. Katz, S. Bello, and A. Hartman, “Left circumflex coronary artery occlusion after mitral valve annuloplasty. “A stitch in time”,” Texas Heart Institute Journal, vol. 39, pp. 104–107, 2012.


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