Abstract
A man aged 74 years presented with acute onset of severe retrosternal chest pain. His medical history included extensive cardiac surgery 8 months prior to his current presentation. It involved mitral valve replacement, tricuspid valve repair, and coronary bypass grafting of the right coronary artery. His troponin level was elevated, and his electrocardiogram showed diffuse ST-segment depression with ST-segment elevation in lead aVR. The patient was found to have an acute coronary syndrome (ACS), and because of persistent chest pain, he was referred for urgent coronary angiography, which showed, in the left circumflex artery, a segment of about 35 mm with 90% narrowing, producing thrombolysis in myocardial infarction grade 2 flow in the artery (Fig.
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