[Myocardial ischemia induced by air bubbles]

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Intraoperative transesophageal echocardiography (TEE) is a valuable tool in cardiac surgery.
• Atrial septal defect (ASD) repair is a common cardiac surgical procedure.
• General anesthesia and cardiopulmonary bypass can pose risks for myocardial ischemia.

Observation:

• During ASD repair, myocardial ischemia was observed approximately five minutes after weaning from cardiopulmonary bypass.
• TEE revealed severe hypokinesis in the anteroseptal, lateral septal, and lateral walls of the left ventricle.
• TEE also detected air bubbles within the left ventricle, preceding ST elevation on ECG.

Findings:

• The observed left ventricular wall motion abnormalities and air bubbles on TEE occurred before electrocardiogram (ECG) ST-segment elevation.
• Pharmacological interventions, including isosorbide dinitrate and nitroglycerin, did not immediately resolve the ischemic changes.
• The myocardial ischemia and associated TEE findings resolved spontaneously within ten minutes.

Implications:

• TEE can detect intraoperative air embolism and myocardial ischemia earlier than standard ECG monitoring.
• This early detection capability of TEE may allow for timely intervention and improved patient outcomes in cardiac surgery.
• TEE provides critical real-time hemodynamic and functional information during complex cardiac procedures.