Bronchovenous fistula - leading to fatal massive systemic air embolism during cardiopulmonary bypass.
OBJECTIVE
We report a case of a bronchovenous fistula in an adult who could not be resuscitated following a mitral valve replacement.


METHODS
A 39-year-old man underwent a mitral valve replacement for severe mitral stenosis and regurgitation. Following uneventful valve replacement surgery, and while attempting to wean the patient off bypass, we encounted a bronchovenous fistula following mechanical ventilation.


RESULTS
This patient could not be resuscitated following surgery because of persistent air embolism in the patient.


CONCLUSIONS
Systemic air embolism has been reported to occur following penetrating chest injury. Especially, when the entry and the exit sites have been over sewn and either a marked Valsalva maneuver by the patient (such as coughing or straining) or forced positive pressure ventilation in excess of 60 torr occurs, systemic air embolism can be created from bronchiolar-alveolar to pulmonary venous fistula. It has also been described in blunt thoracic trauma. Bronchovenous fistula is occasionally encountered in neonates due to ventilation injuries with high ventilatory pressures, especially with underlying lung pathology like respiratory distress syndrome, necessitating such high ventilatory pressures. To our knowledge, this is the first such case reported in the literature.
Doshi
Hari Krishna
HK
Department of Thoracic and Cardiovascular Surgery, Christian Medical College & Hospital, Vellore - 632 004, India.
Thankachen
Roy
R
Philip
Madhu Andrew
MA
Stephen
Thomas
T
Shukla
Vinayak
V
Korula
Roy John
RJ