Although most reports highlight the potential for coronary artery stenosis in the months following valve surgery there are few documented cases of intraoperative coronary embolism causing circulatory collapse and requiring prompt treatment [5]. After Ethical Committee approval and after written consent taken from the patient family for publication, we present a case of acute intra operative left main coronary artery obstruction after Aortic Valve Replacement (AVR) and its immediate management. Case Presentation 41-year-old male patient known to be diabetic, hypertensive and ex-smoker. The patient was presented by shortness of breath on moderate exertion. Patient was subjected for routine work up and investigations which revealed Lymphadenopathy in different anatomical areas including mediastinal LN and Para aortic LN and final diagnosis was pending based on thoracic LN biopsy to be taken on time of cardiac surgery. Patient also diagnosed to have moderate restrictive lung disease and hepatitis B positive with liver impairment. Trans thoracic echocardiography TTE revealed severe mitral regurgitation, severe aortic regurgitation, and mild tricuspid regurgitation. Coronary Angiography showed normal coronaries.