Harish Ram, Aibek Mirrakhimov, Sruthi Rangu, Olivia F Garrett, Vincent L Sorrell
• LV vent malposition is a rare, underrecognized cause of acute pAR. • Intraoperative TEE imaging can be pivotal in real-time diagnosis. • Identification of the mechanism of pAR can directly alter surgical decision-making. • TEE evaluation of LV vent position can prevent potentially serious complications.