Iatrogenic occlusion of the circumflex artery and left ventricle pseudoaneurysm after mitral annuloplasty.

Ischemic iatrogenic lesions can complicate surgical procedures on the mitral valve. One of the causative mechanisms is direct injury to or distortion of the circumflex coronary artery. The risk of damaging the circumflex coronary artery depends mainly upon the proximity of that vessel to the posterior segment of the mitral annulus, and this varies from patient to patient. Herein, we report a case of iatrogenic circumflex coronary artery lesion with left ventricular aneurysm after mitral annuloplasty, in order to highlight a possible relationship between iatrogenic circumflex lesions and coronary dominance in a 70-year-old man who had severe mitral regurgitation. < Learning objective: Although mitral annuloplasty is a simple and reproducible gesture, it requires great technical care to avoid one of the serious complications of occlusion of circumflex coronary artery when crossing stitches. Occlusion can be sudden or gradual (thrombosis after stenosis) as in our case.>.