Massive Systemic and Pulmonary Air Embolism During Atrial Septal Defect Device Closure Managed Successfully by Catheter Aspiration.

INTRODUCTION

Massive air embolism is an uncommon complication during device closure of secundum atrial septal defect (ASD).

CASE SUMMARY: A 60-year-old woman with a large 31-mm ASD with an inadequate inferior-posterior rim was taken for device closure. During initial attempts, the patient developed a massive pulmonary and systemic air embolism with hemodynamic compromise. It was managed with head-low position, pigtail catheter aspiration, intravenous dobutamine infusion, and mechanical ventilation. ASD was successfully closed with a 34-mm device with the modified deployment technique.

DISCUSSION: Massive vascular air embolism is mostly iatrogenic and has been associated with 26% to 45% mortality in noncatheterization lab setting. Massive air embolism during cardiac catheterization procedures is rare and can be fatal. Our cases highlight the approach to management of massive systemic and pulmonary air embolism in the catheterization laboratory.

TAKE-HOME MESSAGE: Early recognition and prompt catheter aspiration could be lifesaving treatment for massive air embolism during ASD device closure.