myocardial infarction | Acta Medica Marisiensis

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

Timea Magdolna Szabo^1,2, Mihaela Ispas¹, Ayman Elkahlout¹

1. Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
2. Pharmaceutical biochemistry and the chemistry of environmental factors, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0013

Introduction: A rare complication of mitral valve surgery is the injury of the circumflex artery due to their close anatomical proximity resulting in a perioperative myocardial infarction and subsequent fibrosis with increased risk of developing ventricular arrhythmias.
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 with 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 attempted, but the procedure failed due to the elastic recoil of the vessel. Our patient received antiarrhythmic therapy and an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death, with no further recorded episodes of ventricular tachycardia.
Conclusion: Although injury of the circumflex coronary artery during mitral valve surgery is described as rare, we strongly believe that increasing awareness of the potential risks involved can further prevent fatal complications.

Objective: The aim of this study was to assess the prevalence of no-reflow after coronary recanalization in anterior acute myocardial infarction with ST-T segment elevation.
Methods: In a cohort of 80 consecutive patients with anterior acute myocardial infarction who were treated with primary angioplasty, we analysed angiographic and clinical characteristic of patients and the prevalence of pre-infarction angina. Successful angioplasty was defined as Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow and residual stenosis less than 50% after the angioplasty procedure. The phenomenon of no-reflow is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction.
Results: Successful angioplasty was achieved in 63 patients (78.75%). Mean age and gender were not different from patients with and without TIMI grade 3 flow. The no-reflow phenomenon was more frequently observed in patients with diabetes (29.41% vs 4.76%, p 0.0001). TIMI grade III flow was higher in the patients with pre-infarction angina (42.86% vs 11.76% p 0.02).
Conclusion: The no reflow phenomenon in patients with anterior acute myocardial infarction treated with primary angioplasty is present in 21.25% of patients. Pre-infarction angina is associated with preservation of the microvasculature, reflected by reduced no-reflow.