In our case, a 46-year-old female with severe aortic insufficiency presented for minimally invasive aortic valve replacement. The patient was taken to the operating room, where transesophageal echocardiography showed severe aortic regurgitation with prolapse of the non-coronary cusp. The patient was placed on a cardiopulmonary bypass machine with peripheral cannulation. The aorta was cross-clamped, and an aortotomy was made. Despite multiple attempts, the left main coronary ostium was not visible. A sternotomy was quickly performed, and a newly discovered chronic type A dissection, obscuring the left main coronary artery, was found. Seventeen minutes after the cross-clamp was placed, the left main was transected, and cardioplegia was delivered. The patient then underwent a Bentall procedure with an aortic valve and root replacement.
Keywords: cardiopulmonary bypass associated vasoplegia; cardiopulmonary bypass circuit; incidental chronic type a dissection; mini thoracotomy; minimally invasive aortic valve replacement; prolonged aortic cross-clamp time; surgical aortic valve replacement (savr).
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