Rapid Deployment Aortic Valve Replacement: Valve of Choice in Patients With a Left Circumflex Anomaly?

von der Linden, Julia; Vlachea, Polyxeni; Herrmann, Florian; Belyaev, Sergey; Juchem, Gerd; Peterss, Sven; Hagl, Christian; Dashkevich, Alexey (2025): Rapid Deployment Aortic Valve Replacement: Valve of Choice in Patients With a Left Circumflex Anomaly? Annals of Thoracic Surgery Short Reports, 3 (2). pp. 420-423. ISSN 27729931

Abstract

We present a successful application of rapid deployment surgical aortic valve replacement in a patient with an anomalous origin of the left circumflex coronary artery, which originated from the right coronary ostium. The patient presented with cardiac decompensation, with resting dyspnea and angina pectoris. Imaging revealed high-grade aortic valve insufficiency, a reduced left ventricular ejection fraction, an aneurysm of the ascending aorta (58 mm), and relevant stenoses of the coronary arteries. She underwent rapid deployment surgical aortic valve replacement, after careful dissection of the left circumflex artery and replacement of the ascending aorta, proximal arch, and bypasses. Her left ventricular ejection fraction improved postoperatively, and there were no complications during the inpatient course and at 1-year follow-up.

The origin of the left circumflex coronary artery (LCX) from the right coronary ostium is the most common coronary anomaly and is often an incidental finding. The course of the LCX artery around the noncoronary sinus of the aortic valve can cause challenges in both surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement.1 Rapid deployment (RD) valves are associated with simplification of implant procedures, reduced intraoperative times, and excellent hemodynamics.2 We report a case of successful implantation of an RD valve in a patient with severe aortic regurgitation, an aortic aneurysm, multiple coronary stenoses, and an atypical origin of the LCX from the RCA ostium.

Our patient, a 73-year-old woman (46 kg, 163 cm) presented with progressive dyspnea at rest (New York Heart Association functional class IV) for several weeks, as well as typical angina (Canadian Cardiovascular Society class IV). At presentation, she showed signs of cardiac decompensation, including pleural effusions. A thoracic computed tomographic scan, performed to rule out pulmonary artery embolism, revealed an ascending aortic aneurysm with a diameter of up to 58 mm, without significant dilation of the aortic root (39 mm × 40 mm). The patient was admitted to our hospital (Department of Cardiac Surgery, LMU of Munich) for completion of diagnostic testing and evaluation of surgical options. Transthoracic echocardiography revealed severe aortic valve regurgitation, no aortic valve stenosis, and impaired left ventricular function (left ventricular ejection fraction, 34%). The left ventricle was dilated, with an end-diastolic diameter of 49 mm and an end-systolic diameter of 35 mm. Coronary angiography revealed 2-vessel coronary disease with significant stenoses of the left anterior descending (LAD) coronary artery and the right coronary artery (RCA). We were surprised to see that the left circumflex (LCX) coronary artery had an anomalous origin from the right coronary ostium (Figure 1).

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Herzchirurgische Klinik und Poliklinik
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892