{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T16:18:48Z","timestamp":1782058728571,"version":"3.54.5"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T00:00:00Z","timestamp":1698364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Occlusion of the left coronary circumflex artery (LCX) during surgical procedures of the mitral valve is an infrequent but potentially life-threatening complication (<jats:xref>1<\/jats:xref>\u2013<jats:xref>3<\/jats:xref>). Due to its close anatomical relationship to the posterior mitral valve annulus, there is a relevant risk of causing a stenosis or an occlusion of the left circumflex artery, especially by surgical annular sutures. The perioperative clinical course is heterogeneous, ranging from\u2014initially\u2014asymptomatic or solely electrocardiographic abnormalities to cardiogenic shock. Both severely impaired ventricular contractility or malignant arrhythmia may potentially lead to a weaning failure from cardiopulmonary bypass (CPB) and eventually result in chronic heart failure with persistently reduced ejection fraction. Possible therapeutic strategies include the immediate reopening of causal sutures, aortocoronary bypass grafting or percutaneous coronary intervention (PCI), yet PCI seems to be the preferred method at present.<\/jats:p>","DOI":"10.3389\/fcvm.2023.1183182","type":"journal-article","created":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T21:35:06Z","timestamp":1698528906000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["When too much closeness harms: circumflex artery injury during mitral valve surgery"],"prefix":"10.3389","volume":"10","author":[{"given":"Christian","family":"Dumps","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Simon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaldas","family":"Girdauskas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Girrbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1016\/j.athoracsur.2010.02.059","article-title":"Echocardiographic identification of iatrogenic injury of the circumflex artery during minimally invasive mitral valve repair","volume":"89","author":"Ender","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1016\/S0003-4975(98)01071-6","article-title":"Damage to the circumflex coronary artery during mitral valve repair with sliding leaflet technique","volume":"66","author":"Tavilla","year":"1998","journal-title":"Ann Thorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1016\/j.athoracsur.2020.05.160","article-title":"Left circumflex artery injury after mitral valve surgery: an algorithm management proposal","volume":"111","author":"Bargagna","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"I1","DOI":"10.1161\/hc37t1.094903","article-title":"Very long-term survival and durability of mitral valve repair for mitral valve prolapse","volume":"104","author":"Mohty","year":"2001","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1093\/ejcts\/ezx324","article-title":"2017 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"52","author":"Falk","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jtcvs.2005.07.060","article-title":"Seven years\u2019 experience with suture annuloplasty for mitral valve repair","volume":"131","author":"Aybek","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1093\/icvts\/ivz050","article-title":"Successful percutaneous treatment of an anomalous left circumflex coronary artery occlusion after tricuspid valve repair","volume":"29","author":"Hergault","year":"2019","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1016\/j.ejcts.2007.07.021","article-title":"Re: injury to the circumflex coronary artery following mitral valve repair","volume":"32","author":"Acar","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1053\/j.jvca.2012.01.010","article-title":"CASE 3\u20132012. 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