An unusual iatrogenic cause of right coronary air embolism

A 62-year-old woman undergoing redo mitral valve replacement was noted to h ave persistent intracardiac air following standard deairing procedures. Tra nsesophageal echocardiography (TEE) identified air bubbles entering the lef t atrium from the right superior pulmonary vein. Exploration of the pleural cavity revealed a fistula between the pulmonary parenchyma and the right s uperior pulmonary vein caused by the atriotomy closure suture transfixing t he edge of the lung, which was repaired with immediate disappearance of the air emboli. This demonstrates that transesophageal echocardiography is an invaluable aid to ensuring complete deairing after open heart procedures. ( C) 1999 by The Society of Thoracic Surgeons.