Emergency PCI after occlusion of the circumflex artery due to minimally invasive mitral valve replacement in re-do operation.

A lesion of the circumflex artery (RCX) is one of the potential complications of mitral valve (MV) surgery. An intraoperative transoesophageal echocardiography (TEE) should be performed for early detection of potential myocardial damage. We report on an emergency PCI after minimally invasive mitral valve replacement in a redo operation. The patient had previously a mechanical aortic valve replacement. A TEE was performed at the end of the redo operation and showed significant signs of segmental myocardial lateral wall dysfunction. A coronary angiogram was performed immediately and a balloon angioplasty and implantation of two stents in the circumflex artery was necessary. In cases of suspected distortion of the RCX, a coronary angiography must be performed without delay to prevent myocardial necrosis.