The incidence and haemodynamic significance of gas emboli during operative hysteroscopy: a prospective echocardiographic study

Leibowitz, David; Benshalom, Neta; Kaganov, Yevgeny; Rott, David; Hurwitz, Arie; Hamani, Yaron

doi:10.1093/ejechocard/jep232

Cited by 30 publications

(25 citation statements)

References 13 publications

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“…TEE-guided studies proved air bubbles during hysteroscopic surgery to occur in 98% of observed patients, without clinical repercussions [3]. Another paper found 85% of operative hysteroscopy patients to exhibit a continuous flow of bubbles through the right ventricle, again without clear clinical signs of an adverse event [2]. The incidence of symptomatic VAE at the author's institution during the studied time interval was surprisingly higher, likely due to a difference in surgical technique (Fig.…”

Section: Discussionmentioning

confidence: 85%

See 1 more Smart Citation

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Dijck

Rex²,

Verguts³

et al. 2017

Gynecol Obstet Invest

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Venous air embolism (VAE) is a rare but potentially fatal complication of hysteroscopic myomectomy. The symptoms of VAE range from mild and clinically insignificant to complete cardiovascular collapse during surgery. Anesthesiologists and surgeons should be aware of the clinical characteristics and predisposing factors of this possible adverse event. This report analyzes 7 cases of VAE, which occurred at the University Hospitals Leuven, in patients undergoing hysteroscopic myomectomy from April 2009 to April 2011. Patient and myoma characteristics were compared to a control group of 27 patients who underwent uneventful hysteroscopic myomectomy during the same period of time. Analysis of baseline data including myoma size failed to identify predisposing factors. Clinical events in this series were classified according to their severity as minor (causing respiratory symptoms in 2 cases), moderate (accompanied by hemodynamic instability in 5 cases), or severe (requiring resuscitation in no cases). Case characteristics and therapeutic strategies in all cases were compared to reports from recent literature.

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Section: Discussionmentioning

confidence: 85%

“…Transesophageal echocardiography (TEE)-guided studies have shown that VAE occurs in the majority of operative hysteroscopies [2,3]. However, these studies have also suggested that these emboli are only rarely clinically significant.…”

Section: Introductionmentioning

confidence: 99%

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Dijck

Rex²,

Verguts³

et al. 2017

Gynecol Obstet Invest

View full text Add to dashboard Cite

show abstract

“…Air bubbles were present in the right atrium (RA) of all patients; this finding was associated with transient desaturation, which resolved without intervention in 30% of cases. While not clinically significant, an increase in pulmonary artery pressure was observed in the majority of those patients [5].…”

Section: Introductionmentioning

confidence: 78%

“…Operative hysteroscopy carries a higher risk of gas embolism [3], with the incidence reaching 10% to 50% in one review [3]. A high incidence of asymptomatic gas embolization was found by Bloomstone et al in 2002, and recently confirmed by Leibowitz et al (2010) using transthoracic echocardiography (TTE) during operative hysteroscopy [4,5]. Air bubbles were present in the right atrium (RA) of all patients; this finding was associated with transient desaturation, which resolved without intervention in 30% of cases.…”

Section: Introductionmentioning

confidence: 97%

Air embolism during operative hysteroscopy: TEE-guided resuscitation

Sabsovich

Abel

Lee

et al. 2012

Journal of Clinical Anesthesia

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“…In particular, the incidence of air embolism during surgery ranges from 7 to 69% as diagnosed by precordial Doppler [108]. Surgical procedures associated with pulmonary embolism include craniotomy [110], cervical spine surgery [111,112], cesarean section [113], laparoscopic cholecystectomy [114], hip arthroplasty [115] and hysteroscopy [116,117]. Additional risk procedures include central venous catheter insertion or removal [118,119], contrast administration [120], and the use of carbon dioxide for the visualization of the anastomosis during the off-pump coronary artery bypass grafting [121].…”

Section: Gas Pulmonary Embolismmentioning

confidence: 99%

Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism

Montagnana

Cervellin

Franchini

et al. 2010

J Thromb Thrombolysis

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Non-thrombotic pulmonary embolism (NTPE) is commonly defined as the partial or total occlusion of the pulmonary circulation caused by a variety of non-thrombotic embolic agents. Although its prevalence is much lower than that of pulmonary thromboembolism, this life-threatening pathology is often underestimated due to the low specificity of signs and symptoms and because it might be frequently overlooked in the differential diagnosis of the chest pain. The main sources of non-thrombotic pulmonary emboli include cancers, fat, infective agents, amniotic fluid, a variety of foreign materials and gases. The diagnosis is particularly challenging. The spectrum of imaging findings using imaging techniques such as computed tomography is unpredictable and typically heterogeneous, whereas laboratory tests can only be helpful for establishing the cause but not the presence of the disease (i.e., D-dimer testing is frequently negative). As such, the clinical history along with the identification a potential underlying disease are the often the mainstay for the differential diagnosis. The aim of this article is to provide an overview of the pathophysiology, clinics and diagnostic approach to NTPE.

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The incidence and haemodynamic significance of gas emboli during operative hysteroscopy: a prospective echocardiographic study

Abstract: Our study demonstrates a high frequency of continuous gas embolism during hysteroscopy, which is associated with a small but statistically significant increase in pulmonary artery systolic pressure without affecting right ventricular function.

Cited by 30 publications

References 13 publications

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Venous Air Embolism during Hysteroscopic Myomectomy: An Analysis of 7 Cases

Air embolism during operative hysteroscopy: TEE-guided resuscitation

Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism

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