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J Thorac Cardiovasc Surg 2004;127:897
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Air embolism caused by blower mister

Department of Cardiac Surgery, University of Leuven, Leuven , Belgium

To the Editor:

We congratulate Nollert and colleagues¹ for their courage in publishing the adverse event experienced with a blower mister while performing a central anastomosis. Especially in off-pump coronary surgery, blower misters are most frequently used for bleeding control while performing the distal anastomoses.²

Gaseous emboli caused by liberal use of the blower mister might additionally result in air locks within coronary vessels. This has been reported verbally, but published evidence is missing. Another complication was published: during performance of an anastomosis in a minimally invasive direct coronary artery bypass procedure, the ventricle was injured, and air embolism was detected with the echocardiography in the heart.³

Air locks in the coronary circulation can lead to ischemia, decreased myocardial contractility, and possibly life-threatening cardiac arrhythmia.⁴ The coronary circulation remains the most difficult compartment from which to remove air bubbles. For this reason and furthermore because of the possibility of endothelial damage, we recommend caution in the use of the blower mister.

	References

Top References

 

1. Nollert G, Oberhoffer M, Reichart B, Vicol C. Combination of the HEARTSTRING proximal seal system with a blower mister: a possible source of gas emboli. J Thorac Cardiovasc Surg. 2003;126:1192–1194[Free Full Text]
   
2. Roy A, Stanbridge RL, O'Regan D, Salerno G, Saldanha C, Griselli M, et al. Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder. Heart Surg Forum. 2000;4:174–178
   
3. Karashima Y, Sha K, Iwatsubo T, Shimoda T, Horiuchi T, Kurita N, et al. Paradoxical embolism during MIDCAB surgery. Masui. 2002;51:673–675[Medline]
   
4. Van Blankenstein JH, Slager CJ, Schuurbiers JC, Strikwerda S, Verdouw PD. Heart function after injection of small air bubbles in coronary artery of pigs. J Appl Physiol. 1993;75:1201–1207[Abstract/Free Full Text]
   

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This Article Full Text (PDF) 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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Helmut Mair Paul Sergeant Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mair, H. Articles by Sergeant, P. Search for Related Content PubMed PubMed Citation Articles by Mair, H. Articles by Sergeant, P. Related Collections Related Article