Carbon dioxide embolism during laparoscopic hepatectomy in a patient with an iatrogenic atrial septal defect:a case report

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Background:Laparoscopic hepatectomy has advantages including shorter hospital stay, lesser blood loss, and lower complication rates. Carbon dioxide gas embolism is a life-threatening complication associated with laparoscopic hepatectomy. During catheter ablation, the standard treatment for atrial fibrillation, an iatrogenic atrial septal defect (ASD) is developed when performing a septal puncture from the right to the left atrium. Case presentation:Carbon dioxide embolism occurred during laparoscopic liver resection in a 70-year-old male patient with a history of catheter ablation for atrial fibrillation. Transesophageal echocardiography detected iatrogenic ASD. The surgery was converted into an open procedure after consulting with the surgeon. Postoperatively, the patient exhibited no evidence of poor arousal nor obvious neurological abnormalities. Conclusion:In patients with a history of catheter ablation, particular attention should be paid to the bubble inflow into the left ventricular system in the event of gas embolism during laparoscopic hepatectomy. J. Med. Invest. 71 : 320-322, August, 2024