オフポンプ冠動脈バイパス術中に冠動脈内に空気塞栓が生じ心停止を来たした一症例

<p>　A 78-year-old man with effort angina pectoris was scheduled for elective off-pump coronary artery bypass surgery. After starting anastomosis of the saphenous vein graft to the posterior descending artery, the patient's hemodynamics suddenly collapsed and he developed cardiac arrest. Cardiac pacing was immediately started, but it was ineffective. Neither direct heart massage nor several injections of vasopressors had an immediate effect. Simultaneous transesophageal echocardiography examination revealed massive gas bubbles in the ascending aorta, and these gas bubbles were suspected to be the cause of the cardiac compromise. After removal of the gas bubbles, spontaneous circulation was recovered. The origin of the gas bubbles was considered to be the air from the air blower that was used to maintain optimal visualization of the operative field. The speculated mechanism for this phenomenon is as follows: The air from the suture site migrated into the collateral artery, which was connected to the septal perforator and the subsequent left anterior descending artery; the air proceeded through the left anterior descending artery in both an antegrade and retrograde fashion; and the left coronary arteries were filled with massive air, which caused the cardiac arrest.</p>