Sudden cardiovascular collapse caused by carbon dioxide embolism during endoscopic saphenectomy for coronary artery bypass grafting

Endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） has gained increasing acceptance as a less invasive alternative to conventional open vein harvesting. With this procedure, carbon dioxide （CO2） is insufflated to create a subcutaneous tunnel to facilitate the harvest of the great saphenous vein. The technique seems to be safe because there are no adverse hemodynamic consequences or systemic CO2 absorption during EVH. We report a case of massive right heart gas embolism which occurred during a routine EVH performance of the saphenous vein. Techniques for early diagnosis of this rare but life-threatening complications, transesophageal echocardiography （TEE） is a sensitive tool in detecting CO2 embolism [except end-tided CO2 （ETCO2）] and pulmonary arterial pressure （PAP） monitoring. The rapid recovery of CO2 embolism in the patient who underwent EVH with CO2 insufflation and CABG surgery was due to immediate and accurate diagnosis and prompt treatment.