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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 4  |  Issue : 1  |  Page : 27-29

Massive cerebral air embolism due to aortography: A case presentation


1 Departmant of Cardiology, Famagusta State Hospital, Famagusta, North Cyprus, Turkey
2 Department of Nursing, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus, Turkey

Date of Submission15-Mar-2022
Date of Decision20-Apr-2022
Date of Acceptance04-May-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Dr. Aydogdu Ozlem
Department of Nursing, Faculty of Health Sciences, Eastern Mediterranean University, Via Mersin 10, Famagusta, North Cyprus
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ACCJ.ACCJ_4_22

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  Abstract 


Though rare, air embolism as a serious complication may occur in patients undergoing coronary angiography and aortography. If gas embolism is diagnosed, hyperbaric oxygen therapy should be initiated immediately after the air source is cutoff and vital functions are stabilized. In this case presentation, a patient went into a coma after a massive iatrogenic cerebral air embolism that developed during the aortography procedure. The patient was discharged with hyperbaric oxygen therapy without any sequelae.

Keywords: Air embolism, aortography, hyperbaric oxygenation


How to cite this article:
Alptekin O, Ozlem A. Massive cerebral air embolism due to aortography: A case presentation. Ann Clin Cardiol 2022;4:27-9

How to cite this URL:
Alptekin O, Ozlem A. Massive cerebral air embolism due to aortography: A case presentation. Ann Clin Cardiol [serial online] 2022 [cited 2022 Sep 29];4:27-9. Available from: http://www.onlineacc.org/text.asp?2022/4/1/27/349339




  Introduction Top


Air embolism is the passage of air sacs into the arterial or venous system. It may develop as a result of accidental injection of air from the syringe into the circulatory system, air passage through the central venous catheter, surgical interventions (especially in surgical procedures in the sitting position), deep diving, and angiographic procedures.[1],[2] Depending on the amount of air and the interaction area, gas embolism may cause serious morbidity and mortality. If a patient is diagnosed with gas embolism, hyperbaric oxygen therapy should be initiated immediately after the air source is cutoff and vital functions are stabilized.[3],[4] Hyperbaric oxygen therapy is breathing 100% oxygen under increased atmospheric pressure. It aims to oxygenate the ischemic region caused by air embolism and minimize or completely eliminate the damage.[4],[5],[6]

Though rare, air embolism may occur in patients undergoing coronary angiography and aortography.[7] In this case presentation, massive cerebral air embolism developed during the aortography procedure and the patient fell into a coma. The patient was discharged without any sequelae after repetitive hyperbaric oxygen therapy.[8],[9],[10]


  Case Report Top


A 69-year-old male patient was admitted to the cardiology clinic with the complaints of exertional dyspnea and angina pectoris for the past few weeks. The patient had chronic renal failure and had been undergoing peritoneal dialysis since 2014. In addition, the endovascular aneurysm repair treatment was applied to the patient due to an advanced abdominal aneurysm. Coronary angiography from the right radial artery was performed due to an ischemic finding in the electrocardiogram angina pectoris. The patient was diagnosed with nonobstructive coronary artery disease. Due to a history of aortic aneurysm, aortography was performed with a pigtail catheter and a contrast injector pump. Accidentally, a significant amount of air entered the ascending aorta of the patient. Because of the opaque substance, bottle of the aortic pump device was not inverted, and the air remained above and was accidentally injected into the patient. The patient lost consciousness immediately. There was no problem with the hemodynamics of the patient. Glasgow coma scale was 3 during the first neurological examination. Cranial computed tomography (CT) showed multiple air sacs in the right watershed area [Figure 1] and [Figure 2]. Hyperbaric oxygen therapy was initiated immediately.
Figure 1: Air sacs in the area shown by the arrows

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Figure 2: Air sacs in the area shown by the arrows

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On day 1, hyperbaric oxygen therapy was performed utilizing the Treatment of the US Navy Dive Manual. The patient had frequent seizures in the pressure cabin. Benzodiazepines were administered to control the seizure attacks. Hyperbaric oxygen therapy continued for 15 days and was performed in accordance with the operating standards proposed in the US Navy Treatment [Table 9]. On day 3, the patient opened his eyes and began to respond to painful stimulus. Clinical improvements were observed on the following days. During this period, the patient received physical therapy. On day 15, the patient started walking without any assistance and was discharged in the following days without any neurological sequelae.


  Discussion Top


The increase in the number of vascular diseases and technological advancements resulted with an increase in the number of angiographic procedures. Air embolism is a serious complication with severe mortality and morbidity rates, which may occur during or after angiographic procedures. Since the phenomenon is rare, the number of studies on air embolism in angiographic procedures is limited. However, cerebral air embolism should be taken into consideration in case of abnormality in the neurological functions of the patient during or after angiographic procedures. When a neurological abnormality occurs, cerebral imaging (CT/magnetic resonance imaging) should be performed and hyperbaric oxygen therapy should be initiated immediately after the diagnosis. Delayed hyperbaric oxygen therapy deepens cerebral ischemia and may cause irreversible tissue loss, resulting in neurological sequelae or death. However, since hyperbaric oxygen therapy is not available in all centers, initiation of the treatment is delayed, which, in turn, results with an increase in mortality and morbidity.


  Conclusion Top


The purpose of this case presentation was to demonstrate the importance of immediate hyperbaric oxygen therapy performed in a patient with cerebral air embolism. We have not found any studies that dealt with the use of hyperbaric oxygen therapy for the treatment of severe and massive cerebral embolism, which developed during the aortography procedure. Thus, the findings of this case presentation may contribute to the literature.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aykan AÇ, Gökdeniz T, Bektaş H, Boyacı F, Gül İ, Hatem E, et al. Assessment of silent neuronal injury following coronary angiography and intervention in patients with acute coronary syndrome. Clin Appl Thromb Hemost 2016;22:52-9.  Back to cited text no. 1
    
2.
Jurga J, Nyman J, Tornvall P, Mannila MN, Svenarud P, van der Linden J, et al. Cerebral microembolism during coronary angiography: A randomized comparison between femoral and radial arterial access. Stroke 2011;42:1475-7.  Back to cited text no. 2
    
3.
Wang H, Zhang X. Magnetic fields and reactive oxygen species. Int J Mol Sci 2017;18:2175.  Back to cited text no. 3
    
4.
Ozan F, Altay T, Kayalı C. Hyperbaric oxygen therapy. TOTBĠD Derg 2017;16:187-95.  Back to cited text no. 4
    
5.
McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: Diagnosis, clinical management and outcomes. Diagnostics (Basel) 2017;7:5.  Back to cited text no. 5
    
6.
Millar IL. Hyperbaric intensive care technology and equipment. Diving Hyperb Med 2015;45:50-6.  Back to cited text no. 6
    
7.
Jain KK, Baydin SA. Textbook of Hyperbaric Medicine. Basel, Switzerland: Springer International Publishing; 2017.  Back to cited text no. 7
    
8.
Moon RE. Hyperbaric treatment of air or gas embolism: Current recommendations. Undersea Hyperb Med 2019;46:673-83.  Back to cited text no. 8
    
9.
Lanke G, Adler DG. Gas embolism during endoscopic retrograde cholangiopancreatography: Diagnosis and management. Ann Gastroenterol 2019;32:156-67.  Back to cited text no. 9
    
10.
Eckmann DM, Zhang J, Ayyaswamy PS. Hydrodynamics and interfacial surfactant transport in vascular gas embolism. ASME J Heat Transfer 2021;143:100802.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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