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We present a case of a 57-year old man with a medical history of hypertension, coronary artery disease, heart failure, and hyperlipidemia. In June 2020 due to endocarditis the patient underwent valve surgery which required implantation of a mechanical valve (SJM 29). The intervention was complicated by postprocedural myocardial infarction (MI) expressed as ST segment elevation. The Heart Team convened ad hoc in the catheterization laboratory and decided on percutaneous coronary intervention (PCI). Coronary angiography revealed total occlusion of the left circumflex artery (Cx) at the origin of the large first marginal obtuse artery (Mo), which additionally presented proximal stenosis (Figure 1 A). The coronary angiography performed before the operation showed no signs of coronary atherosclerosis in these locations.