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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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alan P. Kypson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kypson, A. P. Search for Related Content PubMed Articles by Kypson, A. P. Related Collections Minimally invasive surgery Related Article

J Thorac Cardiovasc Surg 2006;132:1502-1503
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Division of Cardiothoracic Surgery, The Brody School of Medicine, East Carolina University Greenville, NC 27834

I thank Drs Mommerot and Perrault for their contributions to the literature regarding endoscopic vein harvesting and for their comments regarding my recent case report. I would also like to point out the following issues in response to their comments.

The cause of the lesion was not discussed in the article; however, injury to the saphenofemoral junction consisted of a partial tear occurring at the time of initial vein harvest and not at the conclusion of the operation, when the scope was reintroduced into the leg. Nevertheless, carbon dioxide entry into the vascular space was the result of reinsufflation at the conclusion of the case. Drs Mommerot and Perrault are correct in stating that hemostasis is best secured at the time of harvesting and reintroduction of the scope should be minimized. However, if necessary, we do re-examine the tunnel after protamine administration, albeit carefully.

Intraoperative transesophageal echocardiography (TEE) has become a valuable tool for patients undergoing cardiac surgery. We use this technique on all such procedures and do not discontinue its use until the patient is ready for transport to the intensive care unit. In this case, TEE monitoring had been discontinued because the sternotomy incision had been closed. Drs Mommerot and Perrault are correct that TEE is the most effective method for detection of gaseous embolisms. Had the probe been in place during reintroduction of the scope, it might have sooner revealed the impending problem.

In conclusion, endoscopic vein harvesting is a safe procedure with a very low complication rate. Although the incidence of introduction of carbon dioxide into the venous circulation reaches 17%, the incidence of clinically significant outcomes as a result of this remains low. Massive carbon dioxide embolism causing sudden cardiac arrest is highly unusual. Nevertheless, all cardiac surgical teams should be aware of such unlikely events.

Related Article

Carbon dioxide embolism induced by endoscopic saphenous vein harvesting during coronary artery bypass grafting

Arnaud Mommerot and Louis P. Perrault
J. Thorac. Cardiovasc. Surg. 2006 132: 1502. [Extract] [Full Text] [PDF]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alan P. Kypson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kypson, A. P. Search for Related Content PubMed Articles by Kypson, A. P. Related Collections Minimally invasive surgery Related Article