Ligation or distortion of the right circumflex artery during minimal invasive mitral valve repair detected by transesophageal echocardiography

A 43- year- old male patient undergoing mitral valve repair because of severe mitral regurgitation as a result of P2 prolapse was treated with insertion of neochords and a 36 Carpentier- Edwards physio- ring. After weaning from cardiopulmonary bypass, S- T elevation in leads II, III, and aVF occurred. On transesophageal echocardiography an occlusion or distortion of the circumflex artery by ring sutures was suggested, because coronary flow was no longer detected by color Doppler. Despite stable hemodynamics an angiogram was performed, which confirmed the diagnosis of stenosis of the circumflex artery. During reoperation 4 sutures placed at the P1 segment of the mitral valve annuloplasty were corrected. Transesophageal echocardiography could detect a good flow of the circumflex artery and the electrocardiographic changes disappeared.