A patient with anomalous coronary circulation presented with non-ST segment elevation myocardial infarction and ischemic mitral regurgitation and underwent mitral valve repair and coronary revascularization. An unexpected tear occurred in the roof of the left atrium, and its subsequent repair caused iatrogenic damage of the anomalous circumflex artery on its abnormal course requiring an extra graft. Early suspicion of the iatrogenic damage to the anomalous artery was the key for good and complete recovery in this case.
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