title: Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting.
abstract: We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism.
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060-8543, Japan. naohirata@mac.com
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hirata
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kanaya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Sonoda
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Namiki
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002245:Carbon Dioxide; D000075202:Contraindications; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation*; D003331:Coronary Vessels / Q000293:injuries / Q000601:surgery; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006352:Heart Ventricles / Q000293:injuries / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D016896:Treatment Outcome; D014680:Veins / Q000293:injuries / Q000601:surgery
chemical_list: D002245:Carbon Dioxide