Background The circumflex coronary artery is located close to the mitral annulus.
Consequently, it is not immune to iatrogenic damage during mitral valve procedures.
Our objective was to visualize the circumflex artery from a surgeon's point of view,
emphasizing its proximity. Furthermore, comparing it to coronary angiograms might
support preoperative planning. Methods Ten adult human hearts preserved in 4% formaldehyde
solution were investigated (left coronary artery injected with contrast agent). After
performing coronary angiographies from LAO (left anterior oblique) 40/cranial 20,
RAO (right anterior oblique) 10/cranial 40, and true lateral projections, anatomical
preparations were performed. Images were captured throughout the full course of the
circumflex coronary artery from multiple angles. Finally, the mean distances were
measured in every 5mm between the investigated artery and the annulus of the mitral
valve. Results Three-dimensional model of the circumflex coronary artery and its surroundings
was successfully achieved from a left atrial surgical viewpoint. The main branches
were identified on the coronary angiograms. The closest distance was measured under
the region of the left auricle (2.020.69mm; 1-3.1mm). Afterward, the circumflex artery
was observed to make a loop away from the annular region. Conclusion Our observations
show correlation with previous anatomical studies and case reports addressing iatrogenic
lesions on the circumflex coronary artery. Based on all these, we could determine
a "danger zone" on the vessel. The simultaneous evaluation of the anatomical preparations
and the angiograms might improve the acknowledgment of this vulnerable region serving
to avoid any damage to the coronary artery.
