"Air embolism during fontan operation"

Abstract

In patients with a right to left intracardiac shunt, air embolism results in an obligatory systemic embolization. Nonembolization of entrained air is described in a child with a single ventricle physiology who had earlier undergone bidirectional Glenn shunt construction and Damus-Kaye-Stansel anastomosis. The air entrainment was detected by intra-operative transesophageal echocardiography. The combined effect of a "diving bell" phenomenon and mild aortic valve regurgitation are suggested as the reasons for the confinement of air into the ventricle preventing catastrophic systemic embolization.

Intraoperative Transesophageal Echocardiography: A Sensitive and Reliable Tool for Detecting Air Embolism in Real Time

“…When air entrainment into the right chamber of the heart occurs, steep Trendelenburg position traps the air in the apex of the ventricle due to the "diving bell" phenomenon avoiding its dispersion. 2 Packing the sternotomy site with saline-soaked wet sponges and approximating the skin helps further reduce massive entrainment of air.…”

“…Currently, there are limited data about the management of patients with mastocytosis undergoing cardiac surgery with cardiopulmonary bypass (CPB) despite the high theoretical possibility of this type of surgery to act as a trigger for degranulation of MCs. 1,2 We present a case of a 63-year-old woman with severe mitral stenosis secondary to rheumatic disease, mild pulmonary hypertension, and a left ventricular ejection fraction of 44%. The patient was scheduled for mitral valve replacement with a biological prosthesis.…”