Left circumflex artery occlusion during aortic valvuloplasty in a young patient with bicuspid aortic valve: a case report.

Background: Aortic valvuloplasty serves as a valve-preserving alternative to aortic valve replacement and offers advantages in younger patients. However, intraoperative complications associated with this technique have rarely been reported.

Case presentation: A 15-year-old male with severe aortic regurgitation due to a congenital bicuspid aortic valve underwent aortic valvuloplasty. During separation from cardiopulmonary bypass, ST-segment elevation was noted on electrocardiography, and transesophageal echocardiography (TEE) revealed regional wall motion abnormalities. Color Doppler imaging revealed absent flow in the left circumflex artery (LCx). The anesthesiology team promptly alerted the surgeons, and LCx occlusion due to suture annuloplasty was suspected. Removal of the implicated suture restored flow and stabilized hemodynamics.

Conclusions: Systematic intraoperative assessment and documentation of coronary flow via TEE are instrumental in diagnosing coronary artery occlusion. Moreover, mutual trust and clear, timely communication between anesthesiologists and surgeons are essential to maintaining surgical safety.