Abstract
Background The circumflex coronary artery is located close to the mitral annulus. Consequently,
it is not immune to iatrogenic damage during mitral valve procedures. Our objective
was to visualize the circumflex artery from a surgeon's point of view, emphasizing
its proximity. Furthermore, comparing it to coronary angiograms might support preoperative
planning.
Methods Ten adult human hearts preserved in 4% formaldehyde solution were investigated (left
coronary artery injected with contrast agent). After performing coronary angiographies
from LAO (left anterior oblique) 40/cranial 20, RAO (right anterior oblique) 10/cranial
40, and true lateral projections, anatomical preparations were performed. Images were
captured throughout the full course of the circumflex coronary artery from multiple
angles. Finally, the mean distances were measured in every 5 mm between the investigated
artery and the annulus of the mitral valve.
Results Three-dimensional model of the circumflex coronary artery and its surroundings was
successfully achieved from a left atrial surgical viewpoint. The main branches were
identified on the coronary angiograms. The closest distance was measured under the
region of the left auricle (2.02 ± 0.69 mm; 1–3.1 mm). Afterward, the circumflex artery
was observed to make a loop away from the annular region.
Conclusion Our observations show correlation with previous anatomical studies and case reports
addressing iatrogenic lesions on the circumflex coronary artery. Based on all these,
we could determine a “danger zone” on the vessel. The simultaneous evaluation of the
anatomical preparations and the angiograms might improve the acknowledgment of this
vulnerable region serving to avoid any damage to the coronary artery.
Keywords
anatomy - mitral valve surgery - coronary artery
