Pentacuspid aortic valve causing severe aortic regurgitation

Abstract

and cardiopulmonary bypass was established. Ventilation was discontinued, and 2-cm skin incision was made at the 4th intercostal space for assisted window. Then 3 other small skin incisions were made to facilitate insertion of the endoscope and robotic arm. The pericardium was incised to expose the ascending aorta and right side of the heart. The ascending aorta was clamped, and antegrade cardioplegia was delivered from the ascending aorta. The right atrium was incised, and typical primum type ASD was observed. ASD closure with a biologic patch was performed. Cardiopulmonary bypass was tapered and stopped, and the heart started beating by itself. Left-sided single-lung ventilation was restarted. The tidal volume suddenly decreased, and strong positive-pressure ventilation was performed for a few seconds. At that time, sudden short ventricular tachycardia was noted. Moreover, the patient’s blood pressure decreased from 120 mm Hg to 85 mm Hg, and his central venous pressure increased from 5 mm Hg to 12 mm Hg. Transesophageal echocardiography revealed twisted atrial septum. Cardiac herniation was observed directly by endoscope (Video 1). The patient was maintained on durable ventilation, but his hemodynamic condition was unchanged. The left bronchus was blocked, and right-sided single ventilation was started after rotation of the patient’s