Management of late onset recurrent ventricular tachycardia following circumflex artery injury during minimally invasive mitral valve replacement surgery – Clinical case report

Abstract

Introduction: A rare complication of mitral valve surgery is the injury of the left circumflex artery due to their close anatomical proximity resulting in a perioperative myocardial infarction and subsequent fibrosis with increased risk of developing ventricular arrythmias. Case presentation: We hereby describe the case of a 74-year-old male patient, who underwent minimally invasive mitral valve replacement surgery for severe mitral regurgitation two weeks prior to presenting to the emergency department for dyspnea, palpitations and slight thoracic discomfort. He was diagnosed with recurrent sustained monomorphic ventricular tachycardia due to inferior wall myocardial infarction. Angioplasty of the culprit lesion was intended, but the procedure failed due to elastic recoil of the vessel. Our patient received antiarrhythmic therapy and an implantable cardioverter-defibrillator for the secondary prevention of sudden cardiac death, without further episodes of ventricular tachycardia. Conclusion: Although injury to the left circumflex coronary artery during mitral valve surgery is described as rare, we strongly believe that increasing awareness of the potential risks involved, will further prevent fatal complications.