Sim Youna, Hong Boohwi, Park Sang Jun, Shim Man-Shik
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
J Cardiothorac Surg. 2024 Dec 20;19(1):658. doi: 10.1186/s13019-024-03150-7.
Unlike on-pump beating coronary artery bypass grafting, off-pump coronary artery bypass grafting (OPCAB) rarely causes intracardiac air embolisms. However, there have been several reports of air embolisms that occurred during OPCAB using a CO blower, which is commonly used to facilitate visualization of the anastomotic site. Herein, we describe a rare case of air bubbles detected only in the left ventricle during OPCAB.
A 72-year-old man visited our hospital due to a myocardial infarction. Because of diffuse tight stenosis of the coronary artery, urgent OPCAB was performed under median sternotomy. After successful grafting, a significant number of air bubbles were detected in the left ventricle but not in the right side of the heart. To prevent air embolism, the patient was maintained in the Trendelenburg position. The surgery was completed, and no neurological abnormalities were observed during hospitalization.
Air bubbles entered the left ventricle through a specific route. The use of an excessive flow rate of CO blower should be avoided during anastomosis. This case and other similar incidents encourage maintaining vigilant monitoring for air bubbles using transoesophageal echocardiography, even during OPCAB.
与体外循环心脏跳动冠状动脉搭桥术不同，非体外循环冠状动脉搭桥术（OPCAB）很少引起心内空气栓塞。然而，已有几篇关于在使用常用于便于吻合部位可视化的CO吹入器的OPCAB过程中发生空气栓塞的报道。在此，我们描述了1例在OPCAB期间仅在左心室内检测到气泡的罕见病例。
一名72岁男性因心肌梗死前来我院就诊。由于冠状动脉弥漫性严重狭窄，在正中胸骨切开术下行急诊OPCAB。成功移植后，在左心室内检测到大量气泡，但在心脏右侧未检测到。为防止空气栓塞，患者保持头低脚高位。手术完成，住院期间未观察到神经功能异常。
气泡通过特定途径进入左心室。吻合期间应避免使用过高流速的CO吹入器。该病例及其他类似事件提示，即使在OPCAB期间，也应使用经食管超声心动图对气泡进行持续警惕的监测。
