Patent anomalous circumflex coronary artery stent occlusion following aortic valve replacement with coronary artery bypass

An anomalous left circumflex artery branching arising from the right coronary artery is one of the most common congenital coronary artery abnormalities. Despite this, the incidence is low and our clinical understanding of the nuances in patients with such abnormalities remains limited. We present a case of a 73-year-old male with coronary artery disease status-post stenting of an anomalous circumflex artery who subsequently underwent coronary artery bypass grafting and surgical aortic valve replacement with EKG changes post-operatively. He was emergently taken to the cardiac catheterization lab, where catheterization revealed total occlusion of the proximal circumflex artery, just distal to the previous stent. Acute inferior ST-elevation myocardial infarction was suspected to be secondary to intraoperative external manipulation at the site of occlusion in the retro-aortic segment of the vessel. In patients with abnormal coronary artery anatomy, it is imperative to monitor for new EKG changes that may be indicative of new ischemia requiring further intervention.