Efficient Removal of Retained Intracardiac Air Utilizing Buoyancy

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Efficient Removal of Retained Intracardiac Air Utilizing Buoyancy Kazumasa Orihashi, MD The Annals of Thoracic Surgery Volume 102, Issue 6, Pages e587-e590 (December 2016) DOI: 10.1016/j.athoracsur.2016.06.027 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Transesophageal echocardiograms of intracardiac air and retention sites. (A) Bubble type in the left atrium (LA). (B) Pooled type in the right upper pulmonary vein (RUPV), which is masked by acoustic shadow (A-SH). (C, D) Common retention sites include RUPV, LA, left atrial appendage (LAA), left upper pulmonary vein (LUPV), and left ventricular (LV) apex. (A-AO = ascending aorta; RCA = right coronary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2016 102, e587-e590DOI: (10.1016/j.athoracsur.2016.06.027) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Air removal at the early stage of weaning from cardiopulmonary bypass. (A) Pooled air in the right upper pulmonary vein (RUPV) up to the left atrium (LA). (B) Tourniquet for fixing the vent cannula is loosened in the right down position. (C) Atrial orifice of RUPV appears as the air is reduced. (D) R spot: the recess between superior vena cava (SVC) and ascending aorta (A-AO). (E) Digital compression of R spot. (F) Corresponding echogram of R spot compression. (A-SH = acoustic shadow.) The Annals of Thoracic Surgery 2016 102, e587-e590DOI: (10.1016/j.athoracsur.2016.06.027) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Air removal at the later stage of weaning. (A) Transesophageal echocardiogram of air bubbles lining the wall of left atrium (LA) and right upper pulmonary vein (RUPV). (B) Increased venous return and slight elevation of vent cannula. (C) Elevation of superior vena cava (SVC) by forceps. (D) Elevation of left ventricular (LV) apex and reduced amount of air. (E) Compression of the apex approximates the vent cannula to the pooled air. (A-AO = ascending aorta; RV = right ventricle.) The Annals of Thoracic Surgery 2016 102, e587-e590DOI: (10.1016/j.athoracsur.2016.06.027) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions