Document Type : Case Report

Authors

Townsville University Hospital, Townsville, Queensland Australia

Abstract

BACKGROUND: Coronary air embolism (CAE) is a complication that can lead to catastrophic outcomes, including myocardial infarction, stroke, and death. It is reported to occur during cardiac catheterization, within a few hours after cardiac surgery, or as a result of chest trauma. This is a case report of delayed coronary air embolism following cardiac surgery.
CASE PRESENTATION: A 58-year-old female presented with New York Heart Association (NYHA) Class II symptoms resulting from severe, highly eccentric anterior mitral regurgitation from a bio-prosthetic valve. She had preserved ejection function and a total calcium score of zero. This patient underwent a re-do mechanical mitral valve replacement. Two days post-surgery, she was brought to the catheterization laboratory with signs and symptoms suggestive of an inferior myocardial infarction (MI) and complete heart block (CHB). Her symptoms and ST changes resolved immediately after the introduction of angiographic contrast. Angiography revealed no occlusion in the right coronary artery (RCA).

Keywords

  1. Debeaumarché J, Leclercq T, Didier R, Debeaumarché H, Comby PO, Ricolfi F, et al. Acute myocardial infarction related to coronary artery embolism: A systematic cardiac and cerebral magnetic resonance imaging study. Arch Cardiovasc Dis. 2022 Aug-Sep;115(8-9):457-66. https://doi.org/10.1016/j.acvd.2022.05.005
  2. Khan M, Schmidt DH, Bajwa T, Shalev Y. Coronary air embolism: incidence, severity, and suggested approaches to treatment. Cathet Cardiovasc Diagn. 1995 Dec;36(4):313-8. https://doi.org/10.1002/ccd.1810360406
  3. Deshmukh A, Kadavani N, Kakkar R, Desai S, Bhat GM. Coronary artery air embolism complicating a CT-guided percutaneous lung biopsy. Indian J Radiol Imaging. 2019 Jan-Mar;29(1):81-4. https://doi.org/10.4103%2Fijri.IJRI_347_18
  4. Ornelas E, Fernandez-Vilches S, Gallardo X, Mesquida J. Massive coronary air embolism after CT-guided lung needle biopsy. Intensive Care Med. 2018 Oct;44(10):1748-9. https://doi.org/10.1007/s00134-018-5165-1
  5. Dioscoridi L, Roselli E, Melis V, Mutignani M. Air embolism of right coronary artery after ERCP. BMJ Case Rep. 2020 Jun 7;13(6):e236135. https://doi.org/10.1136/bcr-2020-236135
  6. Mukherji J, Hood RR, Edelstein SB. Overcoming Challenges in the Management of Critical Events During Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth. 2014 Jun;18(2):190-207. https://doi.org/10.1177/1089253214526646
  7. Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, Kanaya T, et al. Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism. Circulation. 2015 Jul 28;132(4):241-50. https://doi.org/10.1161/circulationaha.114.015134
  8. Dib J, Boyle AJ, Chan M, Resar JR. Coronary air embolism: a case report and review of the literature. Catheter Cardiovasc Interv. 2006 Dec;68(6):897-900. https://doi.org/10.1002/ccd.20880
  9. Yang HS, Kim JY, Moon SW, Jung JH, Kim DH, Oh YS, et al. A case of coronary air embolism of the left coronary arteries that manifested as cardiogenic shock. Korean Circ J. 2007;37, 334-6. http://dx.doi.org/10.4070/kcj.2007.37.7.334
  10. Park CB, Hwang HJ, Cho JM, Jo BH, Kim CJ. Massive right coronary air embolism in the right coronary artery during left coronary angiography: A case report. Exp Ther Med. 2013 Apr;5(4):1073-4. https://doi.org/10.3892/etm.2013.939
  11. Kihara K, Orihashi K. Investigation of air bubble properties: Relevance to prevention of coronary air embolism during cardiac surgery. Artif Organs. 2021 Sep;45(9):E349-E58. https://doi.org/10.1111/aor.13975
  12. Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017 Sep;61(9):760-7. https://doi.org/10.4103%2Fija.IJA_379_17
  13. Bugge M, Lepore V, Dahlin A. The de-airing clamp in cardiac surgery. Eur J Cardiothorac Surg. 1997 Jan;11(1):189-90. https://doi.org/10.1016/s1010-7940(96)01092-5
  14. Tingleff J, Joyce FS, Pettersson G. Intraoperative echocardiographic study of air embolism during cardiac operations. Ann Thorac Surg. 1995 Sep;60(3):673-7. https://doi.org/10.1016/0003-4975(95)00577-8
  15. Engelmann U, Minden H, Stock UA, Kuhnel R, Albes JM. Late air embolism with interventional removal after isolated coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2006 Jun;131(6):1403-4. https://doi.org/10.1016/j.jtcvs.2006.01.046
  16. Balsara ZN, Burks DD. Hyperbaric oxygen therapy for arterial air embolism. AJR Am J Roentgenol. 2007 Jan;188(1):W98; author reply W99. https://doi.org/10.2214/ajr.06.5595
  17. Kahn JK, Hartzler GO. The spectrum of symptomatic coronary air embolism during balloon angioplasty: causes, consequences, and management. Am Heart J. 1990 Jun;119(6):1374-7. https://doi.org/10.1016/s0002-8703(05)80188-7
  18. Solodky A, Birnbaum Y, Assali A, Ben Gal T, Strasberg B, Herz I. Coronary air embolism treated by bubble aspiration. Catheter Cardiovasc Interv. 2000 Apr;49(4):452-4. https://doi.org/10.1002/(sici)1522-726x(200004)49:4%3C452::aid-ccd23%3E3.0.co;2-i
  19. Patterson MS, Kiemeneij F. Coronary air embolism
    treated with aspiration catheter. Heart. 2005 May;91 (5):e36. https://doi.org/10.1136%2Fhrt.2005.060129
  20. Yew KL, Razali F. Massive coronary air embolism successfully treated with intracoronary catheter aspiration and intracoronary adenosine. Int J Cardiol. 2015 Jun 1;188:56-7. https://doi.org/10.1016/j.ijcard.2015.04.040
  21. Kim DY, Park C, Yu SJ. Cerebral Air Embolism during Open Heart Surgery with Cardiopulmonary Bypass - A Case Report. J Korean Acad Rehab Med. 2011;35:143-8.