A patient with acute circulatory collapse related to coronary air embolism during transcatheter edge-to-edge repair for severe mitral valve regurgitation: A case report

We report an 80-year-old male in whom circulatory collapse related to coronary air embolism occurred during transcatheter edge-to-edge repair (TEER) for severe mitral regurgitation (MR). The patient had a history of heart failure related to severe organic MR (posterior leaflet P2 prolapse). TEER (PASCAL Precision system) was scheduled in consideration that any other treatment could not relieve his symptoms. During the procedure, atrial septal puncture was performed via a right femoral vein approach, and a guide sheath was inserted to the left atrium. Transesophageal echocardiography (TEE) revealed a large number of microbubbles in the left heart system, and electrocardiogram showed ST-segment elevation in leads II, III, aV F , and V1–6, leading to shock. Under a diagnosis of coronary air embolism, chest compressions, vasopressor administration, and air suction through a guide sheath were performed. After hemodynamics recovery was achieved through aggressive resuscitation, the procedure was continued. After all anesthetic agents were discontinued at the end of the procedure, the patient could follow some commands, and tracheal extubation was performed successfully in the operating room. A detailed examination after the procedure revealed no neurological symptoms. Anesthesiologists must perform anesthetic management of TEER cautiously, considering the possibility of coronary air embolism during this procedure.