Protect the Brain When Treating the Heart: Feasibility of 2.5D U-Net for Real-Time Gaseous Microemboli Detection

Gaseous microemboli (GME) represent a common complication of cardiac structural interventions across both surgical and transcatheter approaches. Intraoperative transesophageal echocardiography (TEE) represents a convenient methodology to monitor and visualize the presence of circulating GME. However, their detection and quantification are far from trivial due to operator-dependent view, high velocity, and objects with similar structure in the background. Here, we propose a feasibility study based on a 2.5D U-Net architecture to detect GME in space-time connected data. We applied and tested such an architecture on a pilot dataset of eight TEE recordings (60 fps, 600×800 pixels) from eight different patients undergoing cardiac surgery, resulting in improved detection of moving GMEs against the background with respect to classical spot detection algorithms and 2D U-Net, yet retaining real-time execution speed with respect to more complex deep-learning architectures. Under leave-one-patient-out cross-validation, the selected model achieved strong detection performance under a three-pixel radius-tolerant grace-zone evaluation, with a precision of 92.55% and recall of 80.54%, corresponding to radius-tolerant Intersection over Union (IoU) and Dice coefficients of 73.95% and 84.13%, respectively. Complementarily, strict pixel-based segmentation metrics were also computed, yielding an IoU of 41.74% and a Dice coefficient of 57.98%. The selected model achieved an average inference time of 0.12 s per batch on the tested hardware. To assess specificity on unseen data, we additionally evaluated the model on an external GME-negative TEE dataset, where it produced predominantly empty or near-empty masks, indicating a low rate of spurious detections. These results support the technical feasibility of real-time GME segmentation, although broader clinical validation on larger multi-patient, multicenter datasets is still required.