Inadvertant Coronary Artery Air Embolism Complicating Selective Coronary Angiography

Abstract

Introduction:

The use of coronary angiography in the evaluation of patients with chest pain syndrornes and coronary artery disease has increased by geometric proportion during the last decade. As a result, this study was undertaken to elucidate the clinical features, hernodynamic, and electrocardiographic consequences of inadvertant .coronary artery air embolism. In addition, the etiology and various methods of prevention are commented upon.

Materals and Methods:

The last 1000 cardiac catheteri7ations at Grady Memorial Hospital were examined respective1y. Among this group, there were 750 patients in whom selective coronary angiograrns were performed (approximately 5250 selective injections).  Data from in vitro and in vivo animal experimental studies phis additional case reports were collected from the literature.

Results:

All six cases were studied for diagnostic evaluation of a. chest pain syndrome. One patient age thirty five, had a previously docurnentd, inferior, transmural Inyocard!al infarction.  There were no long term adverse effects in any of the six cases. Follow—up electrocardiog rams were unchanged from baseline in all cases, and myocardial enzymes drawn post catheterizat ion in one patient demonstrated no abnormal elevation.

Discussion:
Although the limitation of such small series is recognized, in these, six patients it appears that air ernhoh which occasionally occur during hand inlection of the coronary arteries, are relatively benign and •result in only transient myocardial ischernia.In cases such as ours where the embolus is seen to go down a vessel unobstructed to a. branch beyond angiographic resolution, observation anti withholding further manipulate ions until EGG changes and chest pain resolve appears to be all that seems needed.