A variety of emboli may be encountered at autopsy. While pulmonary thromboemboli are a relatively common cause of sudden "natural" death, the medical examiner may discover more exotic emboli during the postmortem examination. Other endogenous sources of emboli include the atheromatous debris, bone marrow, fat, liver, brain, trophoblast, and amniotic fluid. Exogenous ("foreign body") emboli may be introduced during medical/surgical procedures or following penetrating trauma. Fatal intravenous air and gas emboli are also well documented. This report details the first case of a fatal suture embolism to the left anterior descending coronary artery following mitral valve replacement. The role of the medical examiner in the investigation of iatrogenic fatalities is discussed.