Postoperative vasoplegic syndrome (VS) is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence of VS after cardiac surgery requiring
cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with
endocarditis undergoing tricuspid valve replacement. When being weaned off
cardiopulmonary bypass, the patient experienced VS. The patient's blood pressure did not increase after the administration of a high dose of
epinephrine and
norepinephrine. Therefore, he was commenced on a low dose of
vasopressin and gradually his blood pressure reached the normal range. Although the standard management of VS is a high dose of vasopressors, this patient was refractory to a combination of
epinephrine and
norepinephrine; only a
vasopressin infusion was able to treat the patient. Eventually, he was weaned from bypass and the operation was terminated satisfactorily. Thereafter, the patient passed the recovery period in the cardiac intensive care unit and was discharged. It seems that
vasopressin is an excellent option in refractory
vasoplegia with minimal response to other vasopressors.