Minimally Invasive Mitral Valve Surgery With Endoaortic Balloon Requires Cerebral Monitoring.

After induction of anesthesia, an extra right radial artery catheter and cerebral oximetry were placed for minimally invasive mitral valve surgery. An anterolateral minithoracotomy, endoaortic balloon, and left atriotomy allowed visualization of the mitral valve. During the procedure, we observed a drop of the right cerebral oximetry saturation without a drop in right radial artery pressure. We suspected an aberrant right subclavian artery. After the endoaortic balloon was repositioned, right cerebral oximetry recovered. A postoperative computed tomography scan revealed an aberrant right subclavian artery. In this case, bilateral upper extremity arterial pressure monitoring would not have detected cerebral hypoperfusion.