Images in Cardiovascular Medicine
Successful Air Bubble Aspiration in the Left Atrium Using Three-Dimensional Transesophageal Echocardiography
2023 Volume 87 Issue 4 Pages 581-
Details
2023 Volume 87 Issue 4 Pages 581-
A 76-year-old woman with severe mitral stenosis (MS) underwent percutaneous transvenous mitral commissurotomy (PTMC). The atrial septum was penetrated to the left atrium (LA) with an SL-0 sheath and RF-Needle (Japan Lifeline, Japan). Her enlarged LA made the insertion of an Inoue balloon (Toray Industries, Japan) into the mitral valve difficult; however, the valve was dilated with the balloon (Figure A). Air bubbles were detected using transesophageal echocardiography (TEE) (Figure B,C). To avoid air embolism, their spatial distribution was assessed using real-time three-dimensional (RT-3D) TEE, before aspiration with an SL-0 sheath (Figure D). Complete aspiration of all bubbles was achieved (Figure E,F; Supplementary Movie). PTMC was terminated without complications. No embolism developed postoperatively, and the patient was discharged 4 days later.
(A) Mitral valve dilation with the Inoue balloon. (B,C) Air bubbles (arrowheads) detected using two-dimensional transesophageal echocardiography (TEE) and real-time three-dimensional TEE. (D,E) Air bubble (arrowheads) aspiration using an SL-0 sheath. (F) Successful complete aspiration.
Rapid removal of the RF-Needle could have created a negative pressure, allowing air to enter the LA from the SL-0 sheath. Iatrogenic air embolism must be avoided. We recommend 3D over 2D TEE because it facilitates understanding the catheter’s orientation and bubble distribution. An SL-0 sheath is suitable for air aspiration in the LA due to its large diameter and ease of control. Although air bubble aspiration is challenging, this strategy may help avoid embolism in cases of air entrapment in the LA.
Written consent was given by the patient.
None.
None declared.
Ethics approval for this single-case analysis was waived by the Ethics Committee of Tokushima Red Cross Hospital.
The data underlying this article are available in the article and its online supplementary movie.
Supplementary Movie. Three-dimensional transesophageal echocardiography showing air bubble aspiration.
Please find supplementary file(s);
https://doi.org/10.1253/circj.CJ-22-0732
