A Case Report of Paradoxical Air Embolism Caused by Intrapulmonary Shunting During Liver Transplantation

Badenoch, Adam; Srinivas, Coimbatore; Al‐Adra, David P.; Selzner, Markus; Wąsowicz, Marcin

doi:10.1097/txd.0000000000000651

Cited by 7 publications

(3 citation statements)

References 9 publications

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“…Transesophageal echocardiography is considered to be the most sensitive monitor for air embolism. TEE may be useful in identifying the size and location of the air embolism as well as intracardiac shunts that allow passage of the air into the arterial circulation [ 5 ]. This modality was not used during this case.…”

Section: Discussionmentioning

confidence: 99%

Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant

Smart

Yaghoubian

2021

Case Reports in Anesthesiology

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Vascular air embolism (VAE) during liver transplantation usually occurs during the dissection phase of the procedure or during liver reperfusion. If this phenomenon occurs, it can cause significant cardiovascular, pulmonary, and neurological complications. Prompt identification of VAE is essential, and the surgeon should be immediately notified. The mainstay treatment is identification and rectification of the source of the air embolus, hemodynamic support, and prevention of further air entrainment. This case report describes the occurrence of a pulmonary air embolism during the preanhepatic phase of an orthotopic liver transplant.

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Section: Discussionmentioning

confidence: 99%

Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant

Smart

Yaghoubian

2021

Case Reports in Anesthesiology

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“…PAE is extremely rare when no intracardiac shunt has been identified, but has been reported following non-neurosurgical cases [6-8]. In 2012, Schlundt et al reported a case of left ventricular air crossover in the absence of a PFO in a neurosurgical patient undergoing resection of a cerebellopontine angle lesion in the sitting position [9].…”

Section: Discussionmentioning

confidence: 99%

Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position

Maragkos¹,

Davanzo²,

Roberts³

et al. 2019

Cureus

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Craniotomy in the sitting position entails risk for venous air embolism (VAE). A 50-year-old male underwent pineal region mass resection through a sitting position craniotomy. Intraoperative transesophageal echocardiography confirmed the absence of intracardiac shunt. During craniotomy, VAE was noted inside the patient’s right heart, leading to hemodynamic instability. After repositioning to the supine position, significant crossover of air into the left heart was noted. Postoperatively, multiple small embolic strokes were noted. Patients who undergo craniotomy in the sitting position and are not found to have a patent foramen ovale (PFO) are not free of risk for paradoxical air embolism (PAE).

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“…Subclinical PAE during orthotopic LT is frequently detected using intraoperative transesophageal echocardiography (TEE). PAE can involve the coronary arteries (leading to myocardial ischemia) or cerebral vessels (leading to ischemic stroke), but serious complications or cases of hemodynamic collapse due to PAE are rare [ 2 – 4 ]. Here, we present a case of severe biventricular dysfunction following allograft reperfusion during an orthotopic LT with hemodynamic collapse preceded by detection of transpulmonary air into the left atrium, left ventricle, and ascending aorta using TEE and ST-segment changes on electrocardiography (ECG) monitoring.…”

Section: Introductionmentioning

confidence: 99%

Intrapulmonary Shunting and Paradoxical Air Embolism in Liver Transplantation: A Case Report

Brown,

Frasco,

Stoker

2024

Am J Case Rep

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Patient: Male, 60-year-old Final Diagnosis: Paradoxical pulmonary thromboembolism Symptoms: Hypotension Clinical Procedure: — Specialty: Anesthesiology Objective: Unusual clinical course Background: A paradoxical air embolism (PAE) occurs when air entering the central venous circulation reaches the systemic circulation, occurring through an intracardiac shunt or intrapulmonary shunting. Patients presenting for liver transplantation often have intrapulmonary shunting due to pulmonary arterial vasodilation, even in the absence of hepatopulmonary syndrome. Here, we present a case of hemodynamic collapse believed to be caused by a PAE, which was diagnosed intraoperatively with transesophageal echocardiography (TEE). Case Report: A 60-year-old man who was diagnosed with non-alcoholic steatohepatitis cirrhosis presented for deceased donor orthotopic liver transplantation with utilization of normothermic machine perfusion. Following reperfusion of the liver allograft, TEE detected intrapulmonary shunting resulting in air within the left atrium, left ventricle, and ascending aorta. The patient developed severe biventricular dysfunction with ST-segment changes on electrocardiography monitoring and became acutely hypotensive with significant hepatic congestion 5 min after liver reperfusion. High doses of inotropic and vasopressor support were used as well as inhaled nitric oxide. The patient recovered after 30 min of medical management. The liver transplantation operation was successfully completed and the patient was discharged home on postoperative day 7. Conclusions: Intracardiac air at the time of reperfusion during liver transplantation can originate from the donor allograft and result in PAE in the setting of intrapulmonary shunting. PAE can result in intracoronary air and should be considered in cases of hemodynamic instability in liver transplantation, especially if air is seen within the left atrium, left ventricle, and ascending aorta.

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A Case Report of Paradoxical Air Embolism Caused by Intrapulmonary Shunting During Liver Transplantation

Abstract: Supplemental digital content is available in the text.

Cited by 7 publications

References 9 publications

Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant

Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant

Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position

Intrapulmonary Shunting and Paradoxical Air Embolism in Liver Transplantation: A Case Report

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