title: Systemic air embolization originating from a pleural air leak via a left ventricular assist device cannula anastomosis site.
abstract: A patient presented with cardiogenic shock, and a left ventricular assist device (LVAD) was inserted. Transthoracic echocardiography demonstrated air in the left side of the heart whenever the patient coughed. A chest x-ray and computed tomography of the chest did not reveal a pneumothorax. Air appeared to enter the left atrium (LA) around the LA cannula. The working diagnosis was a right pleural tear with intermittent passage of air from the pleural space (supra-atmospheric during coughing) into the LA (around the cannula), which contained a large-bore LVAD cannula on -40 mm Hg suction. This was confirmed by inserting a right-sided chest drain, and no air appeared during coughing. This case demonstrates an unusual complication of LVAD use (systemic air embolization) and highlights the point of variable physiology during dynamic versus static imaging procedures.
authors.affiliation: Department of Echocardiography, Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, Brisbane, Australia. dgplatts@hotmail.com
authors.forename: David
authors.initials: D
authors.lastname: Platts
authors.forename: Darryl
authors.initials: D
authors.lastname: Burstow
authors.forename: Christian
authors.initials: C
authors.lastname: Hamilton Craig
authors.forename: Geraldine
authors.initials: G
authors.lastname: Wright
authors.forename: Bruce
authors.initials: B
authors.lastname: Thomson
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects*; D004618:Embolism, Air / Q000000981:diagnostic imaging* / Q000209:etiology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology*; D014463:Ultrasonography