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Carbon dioxide embolism induced right coronary artery ischaemia during off-pump obtuse marginalis artery grafting.

Authors
 Jae Kwang Shim  ;  Yong Seon Choi  ;  Kyung Jong Yoo  ;  Young Lan Kwak 
Citation
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol.36(3) : 598-599, 2009 
Journal Title
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 
ISSN
 1010-7940 
Issue Date
2009
MeSH
Aged ; Carbon Dioxide/adverse effects* ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Coronary Artery Bypass, Off-Pump/methods ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/etiology* ; Coronary Stenosis/surgery ; Embolism, Air/diagnostic imaging ; Embolism, Air/etiology* ; Female ; Humans ; Intraoperative Care/adverse effects ; Intraoperative Complications/diagnostic imaging* ; Ultrasonography
Keywords
Gas embolism ; Off-pump surgery ; Coronary bypass
Abstract
Although use of carbon dioxide (CO2) blower has been regarded safe during off-pump coronary bypass surgery (OPCAB), we experienced a case of right coronary artery ischaemia induced by retrograde CO2 embolism originating from the opened obtuse marginalis artery during OPCAB. The spray pressure can exceed the diastolic pressure, especially during grafting at the lateral or posterior wall when haemodynamic compromise due to mechanical heart displacement is most severe. In this situation, CO2 blowing at an incompletely slinged coronary arteriotomy site can result in retrograde migration of CO2 into the ascending aorta causing coronary embolism of the right coronary artery. When signs of ischaemia on the right coronary artery are encountered during grafting of other coronary artery, although CO2 blower has been used, gas embolism should also be considered as the cause and identified at the mid-oesophageal aortic valve long-axis view. When confirmed, the use of gas blower should immediately be discontinued and coronary perfusion pressure increased while allowing time for the CO2 to be absorbed. In case of massive embolism, needle aspiration of the gas should also be considered
Full Text
http://ejcts.oxfordjournals.org/content/36/3/598.long
DOI
10.1016/j.ejcts.2009.04.062
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104181
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