Subject(s)
Aortic Aneurysm, Thoracic/surgery , Atrial Appendage/diagnostic imaging , Atrial Flutter/diagnosis , Echocardiography, Doppler/methods , Echocardiography, Transesophageal/methods , Vascular Surgical Procedures , Aortic Aneurysm, Thoracic/complications , Atrial Flutter/complications , Humans , Intraoperative Period , Male , Middle AgedSubject(s)
Embolism, Air/diagnostic imaging , Embolism, Air/therapy , Extracorporeal Circulation/methods , Heart Ventricles/diagnostic imaging , Heart-Assist Devices , Adolescent , Cardiomyopathies/complications , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/therapy , Embolism, Air/complications , Humans , Male , Ventricular Function, Right/physiologyABSTRACT
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism. With awake arteriovenous malformation resection following adjunctive Onyx embolization becoming increasingly employed for lesions involving the eloquent cortex, anesthesiologists need to be aware of pulmonary migration of Onyx material as a potential contributor to significant perioperative hypoxemia.