Iatrogenic myocardial infarction. A possible complication of mitral valve surgery related to anatomical variation of the circumflex coronary artery.

Following mitral valve replacement, a 43-year-old male presented electrocardiographic signs of myocardial ischemia-injury in the postero-inferior wall, and subsequently died. The post mortem examination revealed a subendocardial myocardial infarction in the postero-inferior wall. The myocardial infarction was related to the accidental ligation of the circumflex coronary artery by one of the sutures fixing the prosthetic valve. Technically, this surgical accident can be explained by the anomalous origin and course of the circumflex coronary artery found in this patient at the time of the post mortem examination. Anatomical variations of the coronary arteries and their surgical implications are discussed. This iatrogenic complication could have been avoided by performing a preoperative coronary angiography, which was not done in the reported case for medical reasons.