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J Thorac Cardiovasc Surg 2004;128:636-638
© 2004 The American Association for Thoracic Surgery

Brief communication

Venous embolization during sternotomy in children undergoing corrective heart surgery

Ilan Keidan, MDa,*, Yael Mardor, PhDb, Sergei Preisman, MDa, David Mishaly, MDc

a Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
b Advanced Technology Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
c Department of Pediatric Cardiothoracic Surgery, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Received for publication November 2, 2003; revisions received February 3, 2004; accepted for publication March 24, 2004.

* Address for reprints: Ilan Keidan, MD, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer 52621, Israel
keidan@012.net.il

The first 20% of the full text of this article appears below.

Gas embolism results from a negative pressure gradient between veins exposed to air and the central venous pressure.1 The incidence varies according to the procedure, the position, and the detection method used. Venous air embolism (VAE) in cardiac surgery has been previously observed during central venous cannulation and while opening the heart chambers during cardiopulmonary bypass.2 We now describe, for the first time, the detection of VAE by transesophageal echocardiography during sternotomy in children undergoing corrective heart surgery. In addition, we show that sternotomy with scissors significantly reduces the risk of embolization compared with using a saw.

Patients and methods

Patients
Twenty children scheduled for corrective heart surgery were enrolled. Patients with a previous sternotomy were excluded. Patients were randomly assigned to the saw or scissors group. Ten children who underwent sternotomy with a saw had a ventricular septal defect (n = 2), total anomalous pulmonary venous return (n = 1), tetralogy of Fallot (n = 1), truncus arteriosus (n = 1), mitral stenosis (n . . . [Full Text of this Article]






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