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.

Celiac trunk thrombosis is a rare event after percutaneous stenting. Treatment options include surgery or endovascular approach. We report the case of a diabetic female patient of 56 years old with a recurrent chronic mesenteric ischemia related to celiac trunk stenosis. We choose endovascular approach and we performed a stenting of this lesion with a ballon expendable stent of 6 × 29 mm. Acute abdomen occurred at the first postoperative day. Acute mesenteric ischemia was suspected. CT scan objectified a stent thrombosis and beginning of intestinal distress. Because of doubt of intestinal viability, we performed urgently a laparotomy and an anterograde aorto-hepatic bypass. Post-operative course was satisfactory. We put the patient on platelet antiaggregant therapy. One year after, CT scan confirms graft patency. Acute thrombosis of a celiac trunk stenting is an emergency and diagnosis must be performed before the development of end-organ damage. Aorto hepatic bypass can be a good alternative.