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Related Experiment Videos

[Paradoxical embolism during MIDCAB surgery].

Yuri Karashima1, Keiichi Sha, Tomomi Iwatsubo

  • 1Department of Anesthesiology, Nara Medical School, Nara 634-0813.

Masui. the Japanese Journal of Anesthesiology
|July 24, 2002
PubMed
Summary
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A patient experienced cardiac arrest during minimally invasive coronary artery bypass grafting (MIDCAB) surgery due to air embolism. This rare complication, transpulmonary paradoxical embolism, occurred after right ventricular wall injury and air Вlow Вy the Вlower.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Minimally invasive direct coronary artery bypass (MIDCAB) surgery is a less invasive approach for coronary revascularization.
  • Complications during cardiac surgery can arise from various factors, including surgical technique and patient physiology.

Observation:

  • During MIDCAB surgery, a right ventricular wall injury occurred during Left Anterior Descending (LAD) artery exposure.
  • The patient developed hypotension and cardiac arrest, with TEE revealing air bubbles in the right ventricle.

Findings:

  • Air bubbles were suspected to enter the right ventricle through the injured wall via the surgical Вlower.
  • Subsequently, TEE detected bubbles in the left atrium, suggesting transpulmonary paradoxical embolism in the absence of a detectable cardiac shunt.

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Implications:

  • This case highlights a rare but critical complication of air embolism during cardiac surgery.
  • Prompt recognition and management, including chest compressions and medication, are vital for patient survival.
  • TEE is crucial for diagnosing air embolism and identifying potential shunts.