Coronary occlusion after the Manouguian procedure in a patie
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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.

Case presentation
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...

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