title: Coronary occlusion after the Manouguian procedure in a patient with a single coronary artery: a case report.
abstract: BACKGROUND
  The association between the anatomy of a single coronary artery (SCA) and the surgical risk of aortic valve replacement (AVR) remains unclear due to a lack of studies on this topic.
  
  
  METHODS
  A 73-year-old woman underwent AVR for aortic stenosis. Preoperative coronary angiography results showed a SCA arising from the left coronary sinus. The Manouguian procedure was performed for a small aortic annulus. Intraoperatively, an extracorporeal membrane oxygenator (ECMO) was needed for bypass weaning failure due to newly developed right ventricular dysfunction. Coronary angiography was performed on postoperative day 4, and the findings showed a right coronary artery occlusion just after its origin. After emergent coronary artery bypass surgery, she could be weaned from the ECMO. She was discharged on postoperative day 70 and followed up without complications for 12 months.
  
  
  CONCLUSIONS
  AVR with the annular enlargement procedure in those with a SCA can result in an unexpected coronary artery occlusion, which should be, therefore, suspected when unexplained myocardial dysfunction occur. For reducing this risk, the use of a small prosthesis should be considered over the annular enlargement procedure when performing AVR in those with a small aortic annulus and a SCA.
authors: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
authors: Yochun
authors: Y
authors: Jung
authors: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea. drosg@hanmail.net.
authors: Byoung Hee
authors: BH
authors: Ahn
authors: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
authors: Kyo Seon
authors: KS
authors: Lee
authors: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
authors: In Seok
authors: IS
authors: Jeong
authors: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
authors: Sang Gi
authors: SG
authors: Oh
authors: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea.
authors: Kook Joo
authors: KJ
authors: Na
authors: Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea.
authors: Kye Hun
authors: KH
authors: Kim
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*
keywords: Aortic valve replacement; Case report; Coronary artery occlusion; Single coronary artery