Massive right coronary air embolism in the right coronary artery during left coronary angiography: A case report

Abstract

Coronary air embolism is one of the inadvertent complications of coronary angiography. We report a case of unexpected massive right coronary air embolism during left coronary angiography with a JL4 diagnostic catheter. This report demonstrates that air embolism may occur in the contralateral coronary artery and therefore complete air aspiration must be ensured during coronary angiography.

A double complication may yield a positive outcome: air embolism in a huge aneurysm

“…Their patient developed complete atrioventricular block and hypotension. The air bubbles were dispersed distally by forceful injection of contrast dye for several times, and their patient recovered from shock (3). In contrast to our case, in another case report coronary air embolism was resolved by saline flush.…”

“…This unpredictable event may range from an asymptomatic event to even cardiovascular collapse (2). Management of air embolism requires immediate attention and intervention depending on the patient's clinical condition and the size of embolism (3,4). Mechanical and pharmacological management are considered in clinically symptomatic patients (5).…”

Massive coronary artery air embolism due to an unusual cause

“…Coronary air embolism is an uncommon but well-recognized complication of coronary catheterization that occurs in 0.1%–0.3% of cases, most frequently in angioplasty cases [ 1 – 4 ]. Most often, air embolism occurs due to inadequate aspiration and flushing of catheters [ 5 ]. Other possible mechanisms of coronary air embolism that have been described during coronary artery angioplasty are balloon rupture, intraguide catheter suction of air during balloon catheter or guide wire exchanges, structural defects of the equipment, and continuous negative suction of special balloon catheters [ 3 , 5 ].…”

Massive coronary air embolism successfully treated with intracoronary catheter aspiration and intracoronary adenosine

“…There are only 2 reported cases of contralateral CAE in the literature [1,2] with one postulation mentioned being about the possible mixture of the culprit blood-air-contrast bouncing off from the left cusp towards the right cusp and into the RCA [3]. The first steps in the management of CAE are the administration of intravenous saline and high flow oxygen to aid the resorption of the air bubbles.…”

“…The first steps in the management of CAE are the administration of intravenous saline and high flow oxygen to aid the resorption of the air bubbles. When there are significant amount of CAE, the usage of coronary wire, coronary balloon, aspiration catheter and forceful injection of saline or contrast has been advocated [1][2][3][4]. …”