The Auscultation of a Carbon Dioxide Embolization Event during Endoscopic Vein Harvest

Endoscopic vein harvest in preparation for coronary artery bypass surgery has become a preferred method of procuring saphenous vein. Several case reports have documented carbon dioxide (CO(2)) embolization with this procedure as well as CO(2) embolization during other laparoscopic surgeries (Markar et al., 2010). Although uncommon, the potential for CO(2) entrainment through an open vein or through absorption by vascular structures exists and should be recognized (Lin et al., 2003). We report a case of CO(2) embolization during EVH for a 77-year-old patient who underwent CABG that was identified early by the cardiac surgeon through the indirect auscultation of a mill-wheel murmur after the pericardium was opened. This may be the first reported case of a murmur related to air emboli identified without the use of a precordial Doppler probe or a stethoscope. This diagnosis was further supported by TEE before systemic hypotension or cardiovascular collapse occurred.