Unexpected thrombus migration obstructing the right coronary ostium after thoracic aorta graft replacement

Unexpected and reversible causes of ventricular dysfunction requiring a prompt second surgical procedure to restore the cardiac function should always be sought before the initiation of positive inotropic support. We report a case of obstruction of the right coronary ostium by an organized thrombus that had migrated retrogradely from the false lumen of a dissected aortic aneurysm. The resultant ventricular dysfunction hindered separation from cardiopulmonary bypass. Prompt recognition was done by transesophageal echocardiography and a second surgical procedure was immediately performed to remove the thrombus before irreversible ventricular dysfunction occurred.