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

## TL;DR

A young patient with a bicuspid aortic valve experienced a rare complication during aortic valvuloplasty, where a suture caused blockage of a coronary artery, resolved by removing the suture.

## Contribution

This case highlights the importance of intraoperative TEE monitoring and communication to identify and resolve rare complications during aortic valvuloplasty.

## Key findings

- Intraoperative TEE identified left circumflex artery occlusion during aortic valvuloplasty.
- Removing the suture restored coronary flow and stabilized the patient's condition.
- Effective communication between surgical and anesthesiology teams was critical for resolving the complication.

## Abstract

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.

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.

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.

The online version contains supplementary material available at 10.1186/s40981-025-00806-8.