Title: Hemodynamic Consequences of Massive Coronary Air Embolism
Abstract: HomeCirculationVol. 115, No. 4Hemodynamic Consequences of Massive Coronary Air Embolism Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBHemodynamic Consequences of Massive Coronary Air Embolism Anand Prasad, MD, Subhash Banerjee, MD and Emmanouil S. Brilakis, MD, PhD Anand PrasadAnand Prasad From the University of Texas Southwestern Medical School and the Department of Cardiology, Dallas VA Medical Center, Dallas, Tex. , Subhash BanerjeeSubhash Banerjee From the University of Texas Southwestern Medical School and the Department of Cardiology, Dallas VA Medical Center, Dallas, Tex. and Emmanouil S. BrilakisEmmanouil S. Brilakis From the University of Texas Southwestern Medical School and the Department of Cardiology, Dallas VA Medical Center, Dallas, Tex. Originally published30 Jan 2007https://doi.org/10.1161/CIRCULATIONAHA.106.655977Circulation. 2007;115:e51–e53A 60-year-old man underwent coronary angiography because of exertional angina and was found to have a 90% mid–left anterior descending artery lesion (Figure 1A). A 2.5×20-mm paclitaxel-eluting stent was positioned in the lesion. When contrast was injected to verify the stent position, air was introduced into the guide catheter through a loose manifold connection, resulting in a massive coronary air embolism (Movie and Figure 1B). Because the undeployed stent was occlusive, there was no bubble embolization in the distal left anterior descending artery. After 20 s, the patient developed ST elevation and hypotension (Figure 2A), followed by a short period of pulseless electrical activity (Figure 2B). The guide was vigorously aspirated and the stent was deployed. The patient received chest compressions, oxygen and intracoronary atropine, and epinephrine, resulting in complete hemodynamic recovery (5 minutes after initial air embolism) and TIMI (Thrombolysis In Myocardial Infarction) 3 flow in the left coronary artery. The patient had an uneventful recovery, and his troponin-T level increased from <0.01 ng/mL before the procedure to 0.23 ng/mL the following day. Left ventricular wall motion was normal as assessed by transthoracic echocardiography. Download figureDownload PowerPointFigure 1. Diagnostic coronary angiography of the left anterior descending artery in the right anterior oblique cranial projection, showing (A) a severe mid–left anterior descending artery lesion (black arrow) and (B) several coronary intraluminal filling defects attributable to massive air embolism.Download figureDownload PowerPointFigure 2. Electrocardiography and coronary guide used to obtain blood pressure immediately after air embolism (A) showing rapid development of hypotension, followed by the onset of pulseless electrical activity (B).There are few case reports of coronary artery air embolization in the literature, likely because of the underreporting of this complication. Massive air embolism seems to be a rare event.1 Coronary air embolism has been reported to cause chest pain, ST segment elevation, bradycardia, hypotension, and ventricular fibrillation.2 Our case demonstrates that hemodynamic compromise can occur within seconds and may resolve within a few minutes after prompt treatment, which includes aspiration of the air if possible, 100% oxygen administration and (often intracoronary) atropine, and epinephrine injections.3,4Careful preparation of the manifold angioplasty balloons and guiding catheters is crucial to prevent this potentially life-threatening complication.The online-only Data Supplement, consisting of a movie, can be found at http://circ.ahajournals.org/cgi/content/full/115/4/e51/DC1.DisclosuresNone.FootnotesCorrespondence to Emmanouil S. Brilakis, MD, MSc, Dallas VA Medical Center (111A), 4500 South Lancaster Rd, Dallas, TX 75216. E-mail [email protected]References1 Khan M, Schmidt DH, Bajwa T, Shalev Y. Coronary air embolism: incidence, severity, and suggested approaches to treatment. Cathet Cardiovasc Diagn. 1995; 36: 313–318.CrossrefMedlineGoogle Scholar2 Kahn JK, Hartzler GO. The spectrum of symptomatic coronary air embolism during balloon angioplasty: causes, consequences, and management. Am Heart J. 1990; 119: 1374–1377.CrossrefMedlineGoogle Scholar3 Lee WL, Chin CS, Lai CJ, Ho HY, Ting CT. Successful resuscitation of patient with massive coronary air embolism occluding two vessels during coronary angiography: a case report. Angiology. 2001; 52: 155–159.CrossrefMedlineGoogle Scholar4 Patterson MS, Kiemeneij F. Coronary air embolism treated with aspiration catheter. Heart. 2005; 91: e36.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Brilakis E (2021) Acute vessel closure Manual of Percutaneous Coronary Interventions, 10.1016/B978-0-12-819367-9.00025-1, (409-420), . Li Z, Li G, Li Y, Chen Y, Li J and Chen H (2021) Flow field around bubbles on formation of air embolism in small vessels, Proceedings of the National Academy of Sciences, 10.1073/pnas.2025406118, 118:26, Online publication date: 29-Jun-2021. Brilakis E (2018) Complications Manual of Chronic Total Occlusion Interventions, 10.1016/B978-0-12-809929-2.00012-0, (367-439), . Lim M (2018) Complications of Percutaneous Coronary Interventions The Interventional Cardiac Catheterization Handbook, 10.1016/B978-0-323-47671-3.00010-7, (261-285), . Bortolussi G, Cucchini U, Napodano M, Gerosa G and Bottio T (2015) Comment to 'Video-assisted minimally invasive mitral valve surgery: transitioning from sternotomy to mini-thoracotomy', Multimedia Manual of Cardio-Thoracic Surgery, 10.1093/mmcts/mmv003, 2015:0, (mmv003-mmv003), Online publication date: 27-Apr-2015. Wagner J, Sampson C and Bausano B (2015) SCUBA: air embolism SimWars Simulation Case Book: Emergency Medicine, 10.1017/CBO9781107111011.025, (100-103) Siddiqui M, Sami S, Atiq M and Amanullah M (2015) Intraoperative Air Embolism Originating From a Pulmonary Vein, World Journal for Pediatric and Congenital Heart Surgery, 10.1177/2150135114563770, 6:2, (304-306), Online publication date: 1-Apr-2015. Shim C, Lee S and Pak H (2013) Coronary Air Embolism Associated With Atrioesophageal Fistula After Ablation of Atrial Fibrillation, Canadian Journal of Cardiology, 10.1016/j.cjca.2013.05.011, 29:10, (1329.e17-1329.e19), Online publication date: 1-Oct-2013. Cook L (2013) Infusion-Related Air Embolism, Journal of Infusion Nursing, 10.1097/NAN.0b013e318279a804, 36:1, (26-36), Online publication date: 1-Jan-2013. Berg R and Lim M (2013) Complications of Percutaneous Coronary Interventions Interventional Cardiac Catheterization Handbook, 10.1016/B978-0-323-08057-6.00004-5, (108-129), . Seeburger J, Borger M, Merk D, Doll S, Bittner H and Mohr F (2009) Massive Cerebral Air Embolism after Bronchoscopy and Central Line Manipulation, Asian Cardiovascular and Thoracic Annals, 10.1177/0218492309102501, 17:1, (67-69), Online publication date: 1-Feb-2009. Cheng T (2009) Coronary embolism, International Journal of Cardiology, 10.1016/j.ijcard.2009.01.005, 136:1, (1-3), Online publication date: 1-Jul-2009. January 30, 2007Vol 115, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.655977PMID: 17261666 Originally publishedJanuary 30, 2007 PDF download Advertisement SubjectsAcute Coronary SyndromesStent