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A 66-year-old man presented for a mitral valve repair for severe MR with Dr. N.

Dr. W was the cardiac anesthesiologist for the case.

The repair was successful, but upon removal of the antegrade cardioplegia needle a hematoma developed in the ascending aorta.

While a dissection could not be seen on TEE, it was clear to the surgeon this needed to be repaired.

The case proceeded to circulatory arrest- the patient cooled, the head packed with ice, and the ascending aorta repaired with a Hemashield graft.

After distal anastomosis, the pump was restarted and rewarming began.

However, the surgeon could not attach the proximal end of the graft.