Compression of an anomalous left circumflex artery after aortic and mitral valve replacement

A 52-year-old gentleman with a history of rheumatic fever presented with dyspnea. Transthoracic echocardiography revealed severe valvular aortic stenosis and severe mitral stenosis. A preoperative coronary angiogram revealed an anomalous left circumflex (LCX) artery arising from the right coronary sinus. The patient underwent aortic and mitral valve replacement. Postoperatively, a non-ST segment elevation myocardial infarction developed, and coronary angiography confirmed subtotal occlusion of the anomalous LCX. An emergent reoperation with surgical revascularization was performed. Intraoperatively, the mechanism of injury to the LCX was determined to be compression of the distal LCX by the sewing ring of the two prosthetic valves.