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J Thorac Cardiovasc Surg 1995;110:1153-1154
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Microembolization during coronary artery bypass grafting

Director, Cardiovascular and Pulmonary Research Center
Allegheny-Singer Research Institute
Pittsburgh, PA 15212

Reply to the Editor:

Dr. Lee is correct in stating that air microembolism can occur through open coronary arteriotomies and could have contributed to the "unknown"source group. Air accumulating in the left atrium or ventricle during the operation is not infrequent, as shown by transesophageal echocardiographic data and our published data demonstrating that lifting the heart to inspect the posterior anastomoses was associated with a significant incidence of abnormal velocity signals in the right middle cerebral artery.

Venting of the ascending aorta with the vent attached to a cardiotomy return roller pump is the most common method now used at Allegheny General Hospital. No specific transcranial Doppler studies have been performed to determine which method of venting results in the least amount of postreperfusion microemboli and whether there is concordance with postoperative clinical outcomes. Dr. Lee's venting method is that used since the dawn of cardiac surgery. It has withstood the test of time as being an excellent way to rid the left ventricle of significant amounts of air. Other techniques may be equally efficacious.

We thank Dr. Lee for bringing this source of microembolism into focus for a directed study.

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard E. Clark Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clark, R. E. Search for Related Content PubMed Articles by Clark, R. E.