Advertisement

General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 10, pp 880–883 | Cite as

Influx of air into the left atrium during lung resection

  • Kenta NakahashiEmail author
  • Hiroyuki Oizumi
  • Jun Suzuki
  • Akira Hamada
  • Hikaru Watarai
  • Satoshi Takamori
  • Mitsuaki Sadahiro
Original Article
  • 114 Downloads

Abstract

Objectives

In this study, we aimed to determine conditions associated with the development of air bubbles in the pulmonary veins during lung resection.

Methods

A total of 28 patients who underwent lung resection at our institution between October 2016 and March 2018 were included in the study. An intraoperative transesophageal echocardiography was conducted, and the influx of air bubbles in the orifice of the pulmonary vein leading to the left atrium was observed during lung resection.

Results

The median age of all patients was 75 years. The study included 13 men and 15 women. Moreover, seven, 14, and seven patients underwent wedge resection, segmentectomy, and lobectomy, respectively. The presence of air bubbles was observed in 15 patients and was detected when the lung parenchyma was cut (13 patients) or compressed (3 patients) using staplers and when an energy device was used (1 patient). No postoperative organ infarction occurred in any patients.

Conclusions

Although the presence of air bubbles was noted in the pulmonary vein during lung resection via transesophageal echocardiography, the clinical condition of the patients in our study did not deteriorate. The clinical significance of air bubbles is not clear. Therefore, more data about such events must be collected in future.

Keywords

Systemic air embolism Transesophageal echocardiography Air bubbles Lung resection 

Notes

Funding

This study was not supported by a sponsor or funding agency.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to disclose.

Supplementary material

Video 1: We identified air bubbles during transesophageal echocardiography when the lung parenchyma was cut. The patient in this figure is the same as the one in Fig. 1. (MPG 7066 KB)

References

  1. 1.
    Bateman BT, Schumacher HC, Wang S, Shaefi S, Berman MF. Perioperative acute ischemic stroke in noncardiac and nonvascular surgery: incidence, risk factors, and outcomes. Anesthesiology. 2009;110:231–8.PubMedGoogle Scholar
  2. 2.
    Ohtaka K, Hida Y, Kaga K, Kato T, Muto J, Nakada-Kubota R, et al. Thrombosis in the pulmonary vein stump after left upper lobectomy as a possible cause of cerebral infarction. Ann Thorac Surg. 2013;95:1924–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Yamamoto T, Suzuki H, Nagato K, Nakajima T, Iwata T, Yoshida S, et al. Is left upper lobectomy for lung cancer a risk factor for cerebral infarction? Surg Today. 2016;46:780–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006;59:60–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Nakano T, Shimizu K, Otani Y, Kakegawa S, Morishita Y, Taketoshi I. Cerebral air embolism complicating computed tomography-guided percutaneous needle biopsy of the lung: a case report with effective hyperbaric oxygen therapy. Jpn J Chest Surg. 2007;21:859–64.CrossRefGoogle Scholar
  6. 6.
    Matsuura Y, Watari M. Two cases of air bubble in intracardiac cavity after computed tomography-guided lung puncture. Jpn J Chest Surg. 2010;24:967–71.CrossRefGoogle Scholar
  7. 7.
    Sakiyama S, Kondo K, Matsuoka H, Yoshida M, Miyoshi T, Yoshida S, et al. Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg. 2003;126:1207–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol Diagn. 1976;17:813–28. (Stockh) CrossRefGoogle Scholar
  9. 9.
    Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol. 2002;75:731–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Yamashita Y, Mukaida H, Hirabayashi N, Takiyama W. Cerebral air embolism after intrathoracic anti-cancer drug administration. Ann Thorac Surg. 2006;82:1121–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Menendez-Gonzalez M, Oliva-Nacarino P, Alvarez-Cofino A. Cerebral gas embolism caused by pleural fibrinolytic treatment. Stroke. 2007;38:2602–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Schneider F, Lion R, Kummerlen C, Ducrocq X, Tempe JD. Neurological complications and pleural lavage with a fibrinolytic agent. A two-case report. Intensive Care Med. 2000;26:995–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Ohuchi M, Inoue S, Ozaki Y, Ueda K. Systemic air embolism during pleural lavage for empyema. Gen Thorac Cardiovasc Surg. 2017;65:602–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Saada M, Goarin JP, Riou B, Rouby JJ, Jacquens Y, Guesde R, et al. Systemic gas embolism complicating pulmonary contusion. Diagnosis and management using transesophageal echocardiography. Am J Respir Crit Care Med. 1995;152:812–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Shaikh N, Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009;2:180–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hemmerling TM, Schmidt J, Bosert C, Klein P. Systemic air embolism during wedge resection of the lung. Anesth Analg. 2001;93:1135–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Kawaguchi K, Usami N, Taniguchi T, Ishikawa Y, Fukui T, Yokoi K. Systemic air embolism during double sleeve left upper lobectomy: caution regarding this fatal complication. Jpn J Chest Surg. 2013;27:472–6.CrossRefGoogle Scholar
  18. 18.
    Yuki D, Kawano O, Fukai I. Systemic air embolism during wedge resection of the lung: Report of a case. Jpn J Chest Surg. 2015;29:798–802.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Faculty of Medicine, Second Department of SurgeryYamagata UniversityYamagataJapan

Personalised recommendations