Iatrogenic acute aortic insufficiency can occur during surgery on any cardiac structure in close proximity to the aortic valve. This is owing to the central location of the aortic valve in the fibrous skeleton of the heart, thereby making the aortic valve susceptible to injury. 1 We present 2 cases of iatrogenic acute aortic insufficiency during mitral valve replacement. In our first case, the diagnosis was missed during the initial intervention, thereby, requiring a second cardiac procedure within 1 week. In our second case, the diagnosis was made immediately upon an attempt to wean off cardiopulmonary bypass, and the aortic valve was replaced during the initial procedure. The purpose of this report is to increase awareness of this complication and to stress the importance of a complete intraoperative transesophageal echocardiogram (TEE) study to detect the new finding and treat the complication of iatrogenic acute aortic insufficiency in the same perioperative setting. ' Case Report 1Our first patient was a 37-year-old woman with obesity, uncontrolled diabetes, and history of tobacco use who presented with cardiogenic
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