The Case of the "Disappearing Ventricle": A Report

TL;DR

A patient undergoing heart surgery experienced a dangerous gas embolism that obscured heart imaging, requiring high blood pressure and teamwork to resolve.

Contribution

Highlights a rare complication during heart surgery and emphasizes the role of imaging and collaboration in managing it.

Findings

A small gas embolism can cause cardiac dysfunction and arrhythmias.

Large gas emboli can hinder echocardiography visualization of heart chambers.

Higher blood pressure and time were effective in resolving the gas embolism.

Abstract

Embolization of entrapped intracardiac air represents a significant risk to the patient undergoing open-heart surgery. Entrapment of as little as 0.5 mL of gas in the heart can cause temporary myocardial dysfunction, cardiac arrhythmias, and systemic emboli. In contrast, larger emboli can disrupt the evaluation of heart function by limiting visualization during echocardiography. We present the case of a 67-year-old male who presented with dizziness, nausea, and chest pain. A left heart catheterization revealed multi-vessel disease. Undergoing general anesthesia, the patient received three-vessel coronary artery bypass grafting, mitral valve repair, ring annuloplasty, and left atrial appendage closure. Upon aortic unclamping, transgastric echocardiography showed significant gas almost wholly obscuring the left heart chambers despite de-airing maneuvers. Successful resolution relied upon higher mean blood pressure and time, demonstrating the importance of intraoperative imaging and interdisciplinary collaboration.

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