Circumflex Coronary Artery Lesion and Consequent Papillary Muscle Rupture after Chordal Sparing Mitral Valve Replacement.

: Ischemic iatrogenic lesions can complicate surgical procedures on the mitral valve. One of the causative mechanisms is direct injury to or distortion of structures that lie in close proximity to the valve, such as the circumflex coronary artery. We report a case of iatrogenic circumflex coronary artery lesion after mitral replacement causing muscle wall dyskinesia, wall aneurism and papillary muscle rupture. We emphasize the role of post-operative echocardiography in the diagnosis of such complications by demonstrating a 25mm flail of a ruptured papillary muscle remaining sutured to the ring of the mitral prosthesis and moving freely inside the left ventricle intruding the aortic valve during systole.