Paradoxical air embolism from patent foramen ovale in scoliosis surgery.
METHODS
A case was reported in which paradoxical air embolism arose from the patent foramen ovale in scoliosis surgery.


OBJECTIVE
To present a case of suspected paradoxical air embolism after scoliosis surgery.


BACKGROUND
Embolic accident during scoliosis surgery may be caused by air, thrombus, or fat. There is growing attention on patent foramen ovale involved in paradoxical embolism. The devastating consequences are caused by multiple artery occlusions.


METHODS
Details of a recent documented neurologic complication (paraplegia, weakness of right arm, and blurry vision) after scoliosis surgery have been analyzed in medical publications.


RESULTS
The surgical procedure was not imputed. The causative role of epidural catheter for analgesia was considered, but it is likely that a paradoxical embolism occurred in this case, based on the multifocal (cerebral and spinal) neurologic dysfunction, the evidence of cerebral ischemia (on computed tomography), and the presence of a patent foramen ovale (on postoperative transesophageal echocardiography). Although no intraoperative embolism detection was available, air embolism was highly suspected because there was no absolute argument to exclude cruor or fatty embolism.


CONCLUSIONS
It is critical to detect a patent foramen ovale before surgery and cerebral embolization intraoperatively. This might permit ascertainment of the etiologic diagnosis in case of a complication in surgery for scoliosis.
Pham Dang
Charles
C
Service d'Anesthésie-Réanimations, the; Laboratoire d'Explorations Fonctionnelles, Clinique Chirurgicale Orthopédique, Hôtel-Dieu, University Hospital, Nantes, France. charles.phamdang@chu-nantes.fr
Péréon
Yann
Y
Champin
Philippe
P
Delécrin
Joël
J
Passuti
Norbert
N
D001174:Arthrodesis; D004562:Electrocardiography; D019320:Embolism, Paradoxical / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology; D007431:Intraoperative Complications / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012600:Scoliosis / Q000150:complications* / Q000601:surgery; D020758:Spinal Cord Vascular Diseases / Q000175:diagnosis* / Q000209:etiology; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed