The growth in percutaneous transluminal devices has enabled operators to tackle more complex, native, and post-bypass surgery\nanatomy. However, complications such as coronary artery dissection, coronary perforation, retrograde aortic dissection, arrhythmias,\nand acute coronary syndrome still occur with resulting mortality rates of up to 4.2% in complex interventions.\nPerforation of the circumflex artery is of particular interest in view of its position and relation to the surrounding cardiac\nstructures. This is a site of potential fluid collection, and as the left atrium is fixed to the parietal pericardium at the entry of the\npulmonary veins, fluid in the oblique sinus can accumulate enough pressure to compress the left atrium and the coronary sinus.\nWe present a case of left circumflex artery perforation which demonstrates the physiologic complications of coronary sinus and\nleft atrial compression and the resultant functional mitral stenosis
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