Mitral annuloplasty causing left circumflex injury and infarction: Novel use of intravascular ultrasound to diagnose suture injury

Suture injury of the left circumflex coronary artery and infarction may be an under-recognized complication of mitral valve annuloplasty. Our cases illustrate a potential role for early coronary angiography in patients who have persistent hemodynamic instability or ventricular irritability, which may be related to left circumflex artery injury. This potentially devastating complication of mitral annuloplasty can be diagnosed by use of intravascular ultrasound to distinguish suture injury from an atherosclerotic lesion.