Coronary air embolism
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Coronary Angiography | |
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General Principles | |
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Anatomy & Projection Angles | |
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Normal Anatomy | |
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Anatomic Variants | |
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Projection Angles | |
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Epicardial Flow & Myocardial Perfusion | |
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Epicardial Flow | |
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Myocardial Perfusion | |
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Lesion Complexity | |
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ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis | |
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Lesion Morphology | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]
Synonyms and keywords: Coronary artery air embolism; coronary air embolization
Overview
Coronary air embolism is a complication of coronary angiograpghy, in which there is an iatrogenic introduction of gas bubbles into the blood stream, that can be associated with high morbidity and even mortality. In this case, the signs and symptoms result from the cessation of the blood flow within the arterial segment, caused by even a small amount of bubbles, which lead to tissue ischemia from oxygen starvation and may cause cellular damage and irreversible injury. The most dangerous consequences occur in brain and heart due to their vulnerability to short periods of ischemia.[1]
Definition
The coronary air embolism is a result from the iatrogenic introduction of gas bubbles into the blood stream.[1]
Pathophysiology
The introduction of an air bubble in the coronary microcirculation can be explained by Laplace's law and may result in development of an air lock. Laplace’s law relates the pressure difference over a blood–air interface to the surface tension and the radius of the blood–air interface. The predominant mechanism is the air diffusion into the blood and surrounding tissues, leading to bubble shrinking, in wich, the severity of the cardiac impairment is related to the volume of air injected into the coronary arteries, the baseline cardiac function, and subsequent vascular responses such as vasospasm or distal air-lock. However, the size and volume of the bubbles have the most important roles in blood flow speed restoration. Furthermore, this diffusion is significantly enhanced by an increase in the mean arterial pressure and the partial pressure of oxygen in the arterial system.[2] Both conditions and also vasoconstriction may cause a division of bubbles more proximal in the vascular bed leading to more rapid dispersion of bubbles which develop a deleterious effect on the microvasculature decreasing the capillary bed space and so leading to a decrease in distal coronary blood flow.[1]
Cause
Iatrogenic Coronary Embolism
- Surgical coronary artery bypass grafting operation
| Mechanisms that may lead to air embolism during PTCA[3] | |
| 1 | Incomplete aspiration of guiding catheter upon introduction into the vasculature |
| 2 | Balloon leakage or rupture |
| 3 | Prolonged negative suction of self-venting balloon catheters left outsidethe patient |
| 4 | Introduction of balloon catheters into the guiding catheter |
| 5 | Removal of balloon catheters from deeply seated guiding catheters |
| 6 | Structural failure of catheter |
Epidemiology and Demographics
Risk Factors
Signs and Symptoms
- Rapid onset of chest pain
- Electrocardiographic evidence of myocardial ischemia or injury
- Systemic blood pressure may be unaffected or may decline mildly
- The effects clear spontaneously within 5 to 10 minutes in most part of the cases
Rare Signs and Symptoms
Diagnosis
Clinical Significance
Treatment
- 100% oxygen
- Face mask
- Hyperbaric oxygen therapy for cases of massive arterial air emboli[3]
- Analgesics
- Monitorand treat arrhythmias
- Circulatory support with pressors and intra-aortic balloon pump counter pulsation as necessary[4]
- Intracoronary thrombus aspiration catheter systems which are the best options to resolve intracoronary air embolisms safely and harmlessly.[5]
Example
 (Left Anterior Descending Artery; RAO Caudal) |
References
- ↑ 1.0 1.1 1.2 Dib, J.; Boyle, AJ.; Chan, M.; Resar, JR. (2006). "Coronary air embolism: a case report and review of the literature". Catheter Cardiovasc Interv. 68 (6): 897–900. doi:10.1002/ccd.20880. PMID 17086533. Unknown parameter
|month=ignored (help) - ↑ Van Blankenstein, JH.; Slager, CJ.; Schuurbiers, JC.; Strikwerda, S.; Verdouw, PD. (1993). "Heart function after injection of small air bubbles in coronary artery of pigs". J Appl Physiol (1985). 75 (3): 1201–7. PMID 8226530. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 Cheng, TO. (2009). "Coronary embolism". Int J Cardiol. 136 (1): 1–3. doi:10.1016/j.ijcard.2009.01.005. PMID 19181402. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Kahn, JK.; Hartzler, GO. (1990). "The spectrum of symptomatic coronary air embolism during balloon angioplasty: causes, consequences, and management". Am Heart J. 119 (6): 1374–7. PMID 2353622. Unknown parameter
|month=ignored (help) - ↑ Celik, A.; Ozeke, O. (2010). "Management of coronary air embolism during coronary stenting". Kardiol Pol. 68 (6): 716–8, discussion 719. PMID 20806212. Unknown parameter
|month=ignored (help)