Air in the left ventricle

Abstract

A 79-year-old man was admitted with diagnosis of septicemia. During his week-long stay in the hospital, he was treated with parenteral antibiotics and other supportive care with which he improved clinically and was to be discharged. However, he developed acute onset breathlessness followed by hemodynamic collapse and cardiorespiratory arrest. Cardio pulmonary resuscitation was initiated, and he was successfully resuscitated. Urgent bedside echocardiography revealed air in the left atrium (LA) and left ventricle. Color Doppler and contrast echocardiography failed to demonstrate any intracardiac or pulmonary arteriovenous shunt. Central venous (CV) line was removed just before discharge and the procedure was performed at siting posture probably with open hub of CV catheter. Hence, we assume large amount of air must have been entered into the venous circulation and passed across the pulmonary capillary bed into the left heart. Paradoxical air embolism to LA and ventricle is well known, where air enters into the venous circulation at a very rapid rate and exceeds the maximum volume of air that the pulmonary vasculature can filter.

Keywords

• air in the left atrium and ventricle