A variety of approaches are used for mitral valve repair and replacement operations. Rare complications specific to the surgical method may need to be considered if patients encounter unexplained problems postoperatively. We discuss such an example here. The operative approach to the mitral valve in this case was transseptal (from the right atrium), a method which has been widely used as an alternative to the more frequently employed left atriotomy.^1,2 There are certain situations in which the transseptal approach may be particularly useful — for example, allowing better visualiza

Myocardial infarction (MI) typically occurs in the setting of atherosclerotic coronary artery disease (CAD). However, there are other causes of MI unrelated to atherosclerosis that include spontaneous dissection of the coronary arteries, anomalous origin of coronary arteries, vasculitis, toxins such as carbon monoxide, medications (5-fluorouracil, sumatriptan, ergotamine) and hypercoagulable states.^1–7 Fibromuscular dysplasia (FMD) is a condition typically involving small and medium-sized vessels. It has been rarely described in coronary arteries at autopsy^8–13 in ass

Case Description. A 69-year-old female with hypertension and hyperlipidemia presented with a 2-month history of worsening exertional angina. Nuclear perfusion imaging indicated ischemia in the inferior and inferoposterior walls, with preserved left ventricular function. Coronary angiography was notable for severely calcified vessels and a right dominant circulation. The left anterior descending and left circumflex arteries were free of critical stenosis, but the right coronary artery was tortuous in its proximal segment, with a 99% mid-vessel lesion that appeared as a calcified, obst