Hepatic interstitial laser photocoagulation: demonstration and possible clinical importance of intravascular gas.
OBJECTIVE
To investigate gas formation during hepatic interstitial laser photocoagulation (ILP).


METHODS
In vitro, ILP was performed with a neodymium yttrium aluminum garnet laser on a piece of liver in a water bath. In vivo, nine pigs underwent 24 ultrasound (US)-monitored ILP procedures. Fiber tips were more than 1 cm from (n = 16) or adjacent to (n = 8) intrahepatic veins. The gas production seen on US images was graded on a scale of 0 to 4. Precordial Doppler US was performed in all cases.


RESULTS
In vitro, smoke bubbles emanated from the vessels during ILP. In vivo, US showed intravascular gas production during nine of 15 exposures of at least 500 seconds duration. Gas production scores of 2 or more were recorded for nine exposures. Intracardiac gas was identified on eight precordial Doppler US recordings. All animals survived.


CONCLUSIONS
Gas was detected in the heart during some ILP exposures. Patients with a probe-patent foramen ovale (24% prevalence) could be at risk for paradoxic air embolus during ILP.
Malone
D E
DE
Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Lesiuk
L
L
Brady
A P
AP
Wyman
D R
DR
Wilson
B C
BC
D000818:Animals; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D066298:In Vitro Techniques; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D017075:Laser Coagulation / Q000009:adverse effects*; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D012307:Risk Factors; D013552:Swine; D014463:Ultrasonography