Right coronary cusp perforation after mitral valve replacement.

Secondary to leaflet injury, which is a well-known technical mistake, aortic regurgitation can occur during mitral valve replacement or repair. In most cases, the left or the non-coronary cusps are affected. For the first time, we report the case of a patient who had severe aortic regurgitation due to right coronary cusp perforation after mitral valve replacement. This complication was not identified until reoperation. Had transoesophageal echocardiography (TOE) been used during the first procedure, a delayed reoperation could have been avoided. During mitral surgery, every aortic cusp is at risk and peroperative TOE should be a mandatory procedure.