Pulmonary artery air embolism during off-pump coronary artery bypass grafting

Abstract

　Pulmonary artery embolism during off-pump coronary artery bypass grafting (OPCAB) is rare; however, previous reports have described pulmonary embolism caused by a carbon dioxide blower during repair of the injured right ventricular outflow tract and coronary veins. We describe a rare case of pulmonary artery air embolism during OPCAB without visible tissue injury. After anastomosis of the left internal thoracic to the left anterior descending (LAD) artery, we observed increased pulmonary artery pressure with decreased arterial pressure.

　Transesophageal echocardiography (TEE) revealed gas bubbles in the right heart system; therefore, we diagnosed the patient with pulmonary artery air embolism. The needle inserted for LAD clamping punctured the right ventricle, and air flow observed was attributed to the use of the air blower. It is necessary to manage with TEE carefully to have possibilities to develop air embolism when tissue injury is unclear.