Cerebral Infarction by Paradoxical Gas Embolism Detected Non-Stop Extracorporeal Circulation Tricuspid Annuloplasty Surgery with Real-Time TEE: A Case Report

Abstract

Background: There is a risk of significant complications due to paradoxical gas embolism during tricuspid annuloplasty under non-stop extracorporeal circulation without aortic block. Intraoperative real-time transesophageal echocardiography (TEE) is the most sensitive indicator for the detection of gas embolism. Case: This case present a patent ductus arteriosus (PDA) patient with pulmonary hypertension and severe tricuspid regurgitation scheduled for PDA closure and tricuspid annuloplasty. Intraoperative real-time TEE also showed a large number of small bubbles appearing in the left atrium near the orifice of the pulmonary vein. This case demonstrates that the amount of bubbles from the right heart may have exceeded the gas exchange capacity of the lung and entered the left atrium through the pulmonary vein. The patient delayed awakening after surgery and developed convulsive symptoms, decreased muscle strength of the left extremity, and head MRI suggested the possibility of acute cerebral embolism. Lessons: As a relatively simple tricuspid annuloplasty under non-stop extracorporeal circulation without aortic block, surgical may have catastrophic arterial embolism complications.