Beware of Bubbles: Coronary Air Embolism During Transcatheter Patent Foramen Ovale Closure

Abstract

Coronary air embolism is a rare and life-threatening side effect of endovascular interventions, mostly due to procedure-related causes. A 51-year-old man presented with a history of multiple transient ischemic attacks. Patent foramen ovale was found, and transcatheter closure was considered necessary. During the intervention, ST-segment elevation in leads II, III, and aVF was observed. Emergency coronary angiography revealed a typical air bubble that occluded the distal part of the right coronary artery. After nitrate intracoronary injection, the air bubble was dissolved, and ST-segment elevations were resolved. The electrocardiogram rhythm had turned to atrial fibrillation, and intravenous amiodarone was administered. The patient was closely monitored until sinus rhythm was restored. In this study, the distal RCA occlusion did not cause important hemodynamic instability but provoked an arrhythmia that was later restored. Thorough preparation of the equipment and proper intra-procedural techniques must be followed to prevent this serious complication.

Keywords

• coronary air embolism
• patent foraman ovale
• transcatheter patent foramen ovale closure
• case report