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Ann Thorac Surg 2000;70:1760
© 2000 The Society of Thoracic Surgeons

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Correspondence

Coronary air embolism after cardiopulmonary bypass: letter 1

^a Faculty of Medicine, University of Moron, and, Cardiovascular Center, Dupuytren-Quilmes Private Hospital, Buenos Aires, Argentina,

e-mail: medicina{at}unimoron.edu.ar

To the Editor

Chaudhuri and Hickey [1] described a method for the treatment of coronary air embolism after cardiopulmonary bypass. A 50-mL syringe filled with blood is emptied into the ascending aorta after the aortic cross-clamp is reaplied. The objective is to elevate the pressure in the ascending aorta. The authors remark on the danger in reclamping a calcified or atheromatous aorta.

Various approaches emerge from time to time from the literature about treatments for coronary air embolism during heart surgery. In fact, it is the justified anxiety of the cardiac surgeon when ready to discontinue cardiopulmonary bypass and recognize in his patient a low cardiac output syndrome as a result of decreased myocardial contractility, or repeated cardiac arrhythmia or ischemic changes in the electrocardiogram.

In our current practice, we restart full cardiopulmonary bypass and indicate to the perfusionist the adding of a vasopressor agent to the perfusate. The purpose is to increase the mean pressure to 60 to 70 mm Hg. When the hemodynamic state continues unstable, a gentle finger constriction of the aorta distal to the aortic cannula for a few seconds may help to dislodge air bubbles in the coronary arteries (Fig 1) [2, 3]. Special care must be taken during the finger compression to control the pressure in the arterial line and prevent an excessive raising of the pressure in the ascending aorta. In coronary surgery, it is safer to keep a peak pressure below 100 to 120 mm Hg to prevent bleeding in the coronary anastomoses.

View larger version (165K): [in this window] [in a new window]   Fig 1. Controlled raising of ascending aorta pressure by a gentle finger compression of the aorta distally of the arterial cannula.

1. Chaudhuri N., Hickey M.S.J. A simple method of treating coronary air embolism after cardiopulmonary bypass. Ann Thoracic Surg 1999;68:1867-1868.[Abstract/Free Full Text]
2. Liotta D. Induced selective coronary hypertension during partial cardiopulmonary bypass. Chest 1973;64:673.
3. Liotta D. Selective coronary hypertension. Chest 1975;67:502.[Free Full Text]

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