A 79-year-old woman with severe mitral regurgitation due to endocarditis was admitted to our department in February 2011 for elective mitral valve surgery. Preoperative coronary angiography showed irregularities and a right-dominant coronary network ( Fig. 1 ). As it was impossible to perform plasty during surgery because of significant calcification on P2, the mitral valve was replaced with a Mosaic bioprosthesis (No. 31). After removal to the intensive care unit, the ECG showed ST-segment elevation in inferior leads ( Fig. 2 A ). Emergency cardiac catheterization was performed. There was obstruction of the right coronary artery by a pericardial drain tube approximately in the middle of the PDA ( Fig. 3 A ). PDA flow was fully restored after the drain was pulled back ( Fig. 3 B); the ECG immediately normalized ( Fig. 2 B).
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