title: Massive air embolism in a Fontan patient.
abstract: Most institutions performing cardiopulmonary bypass for congenital heart disease patients use an integrated hard shell cardiotomy and venous reservoir attached to an oxygenator. It is of paramount importance that the integrated reservoir be vented so as not to cause pressurization. A pressurized sealed cardiotomy has been reported to occur secondary to issues with vacuum assisted venous drainage systems as well as improper venting in general. We report a case of air embolus caused by retrograde propulsion of air through the venous line secondary to a pressurized cardiotomy reservoir in a patient with Fontan circulation. The mechanism of cardiotomy pressurization is described, and the scenario simulated in a mock circuit.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts 02115, USA. gregory.matte@cardio.chboston.org
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Matte
authors.forename: Barry D
authors.initials: BD
authors.lastname: Kussman
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Wagner
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Boyle
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Howe
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Sitaram M
authors.initials: SM
authors.lastname: Emani
mesh_terms: D002675:Child, Preschool; D004618:Embolism, Air / Q000209:etiology* / Q000628:therapy; D019544:Equipment Failure Analysis; D018729:Fontan Procedure / Q000009:adverse effects* / Q000295:instrumentation*; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D007431:Intraoperative Complications; D011312:Pressure; D014057:Tomography, X-Ray Computed