Transesophageal Echocardiography–Guided Aspiration of Venous Air Embolism During Liver Transplantation: A Case Report

Abstract

Transesophageal echocardiography can be useful not only in diagnosing venous air embolism but also in guiding aspiration of air from the pulmonary artery. A 59-year-old man with a history of cirrhosis underwent combined kidney and liver transplantations. He developed acute hypotension after the native liver was removed due to a massive venous air embolism via a retained transjugular intrahepatic portosystemic shunt catheter. Transesophageal echocardiography revealed air in the pulmonary artery resulting in outflow obstruction. Under echocardiographic guidance, the pulmonary arterial catheter was withdrawn to the air pocket and aspirated, resulting in improved hemodynamics and successful completion of transplantations.

A 7-month-old girl with a suspected air embolism complication during a living-donor liver transplantation procedure: a case report

“…The peak cTnl of the girl in our report was 7.41 ng/ml, more than 1,000 times the reference limit, at the end of operation. Additionally, transesophageal echocardiography (TEE) is likely to be more helpful in diagnosing an air embolism, revealing the amount of air transiting the right side of the heart and a stream of bubbles entering the left heart, also facilitating image-guided aspiration of trapped air via the center catheter ( 15 ). However, placement of TEE was almost impossible due to space, equipment, and pediatric anatomy at that moment.…”