Review in DepthAnomalous circumflex artery: a benign variant generating a malignant potential after valve surgeryPapakonstantinou, Nikolaos A.a,b; Leontiadis, Evangelosc; Katsaridis, Sotirios D.a; Milonakis, Michaela; Avgerinos, Dimitriosa; Papadopoulos, Kyrillosd; Malakos, Ioannisc; Stavridis, Georgios T.a Author Information a3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece bDivision of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada clnterventional Cardiology Department, Onassis Cardiac Surgery Center dDepartment of Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece Received 29 August 2022 Accepted 12 March 2023. Correspondence to Nikolaos A. Papakonstantinou, MD, MSc, PhD, Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, 770 Bay Street, M5G 0A6, Toronto, Ontario, Canada, Tel: +1 4168875392; e-mail: [email protected] Coronary Artery Disease 34(5):p 364-371, August 2023. | DOI: 10.1097/MCA.0000000000001247 Buy Metrics Abstract Coronary artery anomalies are a diverse group of congenital disorders presenting with highly variable clinical manifestations. The anomalous origin of left circumflex artery from the right coronary sinus following a retro-aortic trajectory is a well-recognized anatomic variation. Despite its benign course, it can prove lethal in association with valvular surgery. When single aortic valve replacement or combined with mitral valve replacement is performed, the aberrant coronary vessel may be compressed by or between the prosthetic rings triggering postoperative lateral myocardial ischemia. If left untreated, the patient is at risk of sudden death or myocardial infarction with its detrimental complications. Skeletonization and mobilization of the aberrant coronary artery is the most widely accepted intervention, but valve downsizing or concomitant surgical or transcatheter revascularization have also been described. However, large series are lacking from the literature. Therefore, no guidelines exist. This study is a thorough review of the literature concerning the aforementioned anomaly in association with valvular surgery. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.