INTRODUCTION
Mitral valve (MV) repair is the procedure of choice for the treatment of severe mitral regurgitation (MR), particularly in degenerative disease with leaflet prolapse. Correction of the leaflets abnormalities enables to recover the valvular function and annular reshaping, by rings or bands, remodels the mitral annulus to adequate size and shape, enhancing the coaptation area and preventing further dilatation. As all surgical procedures, patients undergoing MV repair can experience severe complications before leaving the operative theatre (OR).
Some of them are intrinsic to the mitral disease and to its correction. Systolic anterior motion (SAM), that adds acute left ventricular (LV) obstruction to residual mitral regurgitation (MR) of variable grade, is, perhaps, the most common causes after MV repair for degenerative MR, as, in case of ischemic or secondary MR, it virtually does not exist. Injury to circumflex artery (CX) is an underestimate event, often lethal, that needs immediate recognition and treatment. Both these complications are directly related to MV repair, even if CX injury was first described after MV replacement [1].