Phasic disappearance of left circumflex coronary artery from an early complication of mitral valve surgery.

LV pseudoaneurysm can be a late complication of mitral valve replacement. In our case, it was an early postoperative complication. This pseudoaneurysm was causing compression of LCX artery during systole, leading to presentation of NSTEMI two weeks after the surgery.

A 50-year-old Caucasian female, s/p mitral valve replacement (MVR) for subacute bacterial endocarditis of the mitral valve with Streptococcus viridans presented 2 weeks postoperatively with NSTEMI. Two-dimensional Echocardiogram showed that LVEF was 15% (immediate postoperative EF 2 weeks ago was 55%) and a giant pseudoaneurysm of the posterobasal left ventricular wall (Fig. 1). Coronary angiogram showed left ventricular (LV) pseudoaneurysm and phasic decrease in flow in the left circumflex coronary artery(LCX) during systole due to compression by the pseudoaneurysm (Figs. 2 and 3). No significant intraluminal obstruction of the major epicardial coronary arteries was observed. She underwent repair of the pseudoaneurysm with a bovine pericardial patch. Postoperatively her ejection fraction improved with good resolution of symptoms. This case illustrates that LV pseudoaneurysm can occur in early postoperative period along with the above interesting findings after mitral valve surgery. So far, it has been described in the literature as a late complication 1–3.

Figure 1

2D Echo showing left ventricular pseudoaneurysm (star sign).

Figure 2

Coronary angiogram showing LMCA, LAD and LCX with a prosthetic mitral valve. Arrow pointing to LCX artery.

Figure 3

Coronary angiogram showing LMCA, LAD and disappearance of LCX (arrow) with a prosthetic mitral valve.

Conflict of Interest

None declared.