Harbinger of Difficult Weaning from Cardiopulmonary Bypass in Aortic Valve Replacement Surgery: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic stenosis and anomalous aortic origin of coronary artery (AAOCA) (n=1). Intervention: Surgical revascularization (CABG) of anomalous right coronary artery. Primary outcome: Successful weaning from cardiopulmonary bypass.

Q: What does this research mean for the field?

Prompt recognition of iatrogenic anomalous right coronary artery occlusion via intraoperative transesophageal echocardiography and subsequent surgical revascularization restores right ventricular function and facilitates successful weaning from cardiopulmonary bypass. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Allan Deepak; Balaji Kuppuswamy; Kirubakaran Davis; Shalom Sylvester Andugala

doi:10.4103/aca.aca_290_25

July 1, 2026Annals of Cardiac AnaesthesiaOpen Access

Harbinger of Difficult Weaning from Cardiopulmonary Bypass in Aortic Valve Replacement Surgery: A Case Report

View Full Paper

Ask AI

Bookmark

Share

Key result

Prompt TEE detection and revascularization of an occluded anomalous RCA enables bypass weaning.

n=1

Figures

Why the study?

Failure to wean from cardiopulmonary bypass during aortic valve replacement is a rare but critical intraoperative challenge with multiple potential causes requiring prompt recognition and management.

Key Points

To describe the diagnosis and surgical management of acute right ventricular dysfunction causing cardiopulmonary bypass weaning failure due to an anomalous right coronary artery during aortic valve replacement.
Clinical case evaluation of a 56-year-old male with severe aortic stenosis and an anomalous high-origin right coronary artery undergoing surgical aortic valve replacement with a 23 mm St Jude Regent bileaflet mechanical prosthesis.
Intraoperative transesophageal echocardiography and repeat cardioplegia infusion were utilized to evaluate hemodynamic collapse and verify coronary artery patency.
Emergency revascularization was performed using saphenous vein coronary artery bypass grafting to the right coronary artery.
Transesophageal echocardiography revealed acute right ventricular hypokinesia of the mid and basal free wall with interatrial septum bulging and a central venous pressure of 15 cmH2O during separation attempts.
Inability to achieve flow through the right coronary artery during Delnido root cardioplegia reinfusion confirmed intraoperative coronary occlusion near the aortotomy site.
Coronary artery bypass grafting with a 13-minute cross-clamp time restored ventricular contractility within minutes, allowing cardiopulmonary bypass separation on 0.05 mcg/kg/min adrenaline after 4 hours 19 minutes of total bypass time.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 56-year-old man with severe aortic stenosis and an unrecognized anomalous right coronary artery who experienced difficult weaning from cardiopulmonary bypass during surgical aortic valve replacement.

I

Intervention

Surgical aortic valve replacement (23 mm mechanical prosthesis) followed by emergent coronary artery bypass grafting (CABG) to the RCA using a saphenous vein graft due to iatrogenic coronary compromise.

Intraoperative transesophageal echocardiography is essential for promptly diagnosing unexpected iatrogenic coronary compromise during aortic valve replacement, enabling immediate life-saving surgical revascularization.

Implication

May aid TEE detection of rare coronary anomalies in AVR weaning failure; hypothesis-generating pending prospective data.

Abstract

Failure to wean from cardiopulmonary bypass (CPB) is a rare but critical intraoperative challenge. Common causes include residual structural defects (causing intracardiac shunting, prosthetic valve leaks), left ventricle outflow tract obstruction, ventricular dysfunction, or vasoplegic syndrome. We present the case of a 56-year-old man with severe aortic stenosis who underwent surgical aortic valve replacement. Separation from CPB failed repeatedly due to acute right ventricular dysfunction detected on transesophageal echo. The patient was found to have a congenital anomalous high origin of the right coronary artery (RCA), likely compromised during surgery. Timely recognition and surgical revascularization of the RCA with a saphenous vein graft restored right ventricular function and facilitated successful weaning. This case highlights the importance of intraoperative echocardiography, awareness of anomalous coronary anatomy, and prompt multidisciplinary decision-making in managing difficult separation from CPB.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Deepak et al. (2026) conducted a case report in Severe aortic stenosis and anomalous aortic origin of coronary artery (AAOCA) (n=1). Surgical revascularization (CABG) of anomalous right coronary artery was evaluated on Successful weaning from cardiopulmonary bypass. Prompt recognition of iatrogenic occlusion of an anomalous right coronary artery via transesophageal echocardiography and subsequent surgical revascularization facilitated successful weaning from cardiopulmonary bypass.

synapsesocial.com/papers/6ad0fc263afa093ea9acfc36 https://doi.org/10.4103/aca.aca_290_25

View Full Paper

Ask AI

Bookmark

Share

Harbinger of Difficult Weaning from Cardiopulmonary Bypass in Aortic Valve Replacement Surgery: A Case Report

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Harbinger of Difficult Weaning from Cardiopulmonary Bypass in Aortic Valve Replacement Surgery: A Case Report

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More from Annals of Cardiac Anaesthesia

Keep reading

More related papers

More from Annals of Cardiac Anaesthesia