Echocardiographic characteristics of venous air embolism presenting as reversible pulmonary atresia in a premature neonate

Abstract

Air embolism secondary to mechanical ventilation is a rare but well-described complication in premature infants. We describe the echocardiographic appearance of venous air embolism manifesting as acute obstruction of the right ventricular outflow tract in such a premature infant, and review the pathophysiology of acute obstruction of the right ventricular outflow tract secondary to the "air lock" phenomenon. Awareness of the pathophysiology and echocardiographic appearance of venous air embolism may aid in prompt recognition and potential therapy for this lethal complication of mechanical ventilation.

Cardiac Air Embolism in Neonates: A Hemodynamic Perspective

“…In neonates with severe PHT and absent forward flow across the pulmonary outflow tract due to the air lock and in whom PDA is closed, cardiology service should be consulted urgently and prostaglandins considered to open the duct which might prove lifesaving. 11 In conclusion, CAE is an important complication in neonates that needs urgent diagnosis and prompt management. Unexpected sudden cardiovascular collapse or acute severe PHT are the common presentations.…”

“…In addition to the causes such as pericardial effusion and pneumothorax, cardiac AE (CAE) could be one of the causes of sudden-onset collapse or severe pulmonary hypertension (PHT) in neonates. 11 Hence, it is very critical for neonatal practitioners to be aware about this entity. Literature describing the hemodynamic findings of CAE in neonates is scant.…”

Embolismo aéreo neonatal

“…En casos graves puede presentarse como una atresia pulmonar funcional (Figura 1 D). 12 Esto genera un compromiso súbito, por choque hipovolémico dado al cese del retorno venoso pulmonar al corazón izquierdo, además de hipoxemia grave (en nuestro caso, agravada por la anemia), todo esto lleva a un resultado fatal. 13 En nuestro paciente se detectó una imagen en "cola de cometa" mediante el USG, lo cual ocurre por un fenómeno de reverberación llamado artefacto anular descendente (ring-down artifact).…”