A 3-year-old with tetralogy of Fallot who previously had undergone a complete repair (ie, right ventriculotomy, ventricular septal defect repair, and pulmonary valvuloplasty with a transannular patch across the pulmonic valve creating pulmonic insufficiency) presented for pulmonary valvuloplasty placement to treat right ventricular volume overload from severe pulmonic insufficiency. Severe right ventricular dilation with moderate right ventricular dysfunction was present on the preoperative echocardiographic examination, but, importantly, no residual intracardiac shunts were present. After an uneventful induction of anesthesia, a right internal jugular venous catheter (5F, 8 cm, 2 lumen), a right radial arterial catheter and 2 peripheral intravenous catheters were placed. After sternotomy, the aorta and right atrium were cannulated. VAVD was planned, and a hard shell venous reservoir with a positive-pressure pop-off valve and a vacuum wall source with a regulator were prepared (Figs 1-3 and Video 1 [supplementary videos are available online]). After heparinization, the cardiotomy suction pumps (“pump suckers”) were activated, and the arterial and venous cannulae were placed in anticipation of CPB. Once the venous clamp was removed, there was retrograde air delivery via the venous cannula, creating an air lock and air embolus. Transesophageal echocardiography revealed a large amount of right-sided intracardiac air (Fig 4 and Video 2). Rapid resuscitation with fluid and epinephrine was initiated. A kink in the proximal vacuum-assist silastic tubing was discovered (Fig 2 and 4 and Video 1). The surgeon clamped the venous cannula (which was in the right atrium) and disconnected the venous drainage tubing from the venous cannula. He then unclamped the venous cannula and manually compressed the right heart, allowing egress of air and blood from the right heart out the venous cannula. The venous cannula then was filled with fluid and reconnected to the venous drainage tubing, and CPB quickly was initiated. In this manner, the patient was stabilized, the venous catheter purged of air, the VAVD tubing unkinked, and CPB initiated. The entire episode lasted less than 2 minutes. The remainder of the case proceeded uneventfully, and he was extubated neurologically intact later that day and discharged after 7 days with no apparent sequelae.