Arterial gas embolism (AGE) during mitral transcatheter edge-to-edge repair (m-TEER) is a serious event that may lead to catastrophic consequences. Careful preparation and inspection of the device is mandatory, and it is usually performed through a series of standardized steps. However, AGE may come from “hidden” parts of the device. We present the first described case of AGE-related stroke during MitraClip procedure due to a faulty clip introducer, highlighting the importance of the additional inspection of this given-for-granted portion of the device. Hyperbaric oxygen therapy led to complete patient recovery, although performed more than 18 h after the event, leaving place to the benefits of a successful m-TEER procedure. We reviewed the literature and described all the possible sources of AGE during m-TEER with MitraClip, and the intra and postprocedural management of AGE. In particular, hyperbaric oxygen remains the gold-standard treatment for AGE, and it is effective even when performed outside commonly considered time windows of efficacy for ischemic injuries.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Supporting Information

References

1J. Bessereau, N. Genotelle, C. Chabbaut, et al., “Long-Term Outcome of Iatrogenic Gas Embolism,” Intensive Care Medicine 36 (2010): 1180–1187.
10.1007/s00134-010-1821-9
PubMed Web of Science® Google Scholar
2M. G. Wysoki, A. Covey, J. Pollak, M. Rosenblatt, J. Aruny, and N. Denbow, “Evaluation of Various Maneuvers for Prevention of Air Embolism During Central Venous Catheter Placement,” Journal of Vascular and Interventional Radiology 12 (2001): 764–766.
10.1016/S1051-0443(07)61451-1
CAS PubMed Web of Science® Google Scholar
3I. Kutkut, E. Worrall, N. Pal, et al., “Coronary Air Embolism and Pneumomediastinum After a MitraClip Procedure,” JACC: Cardiovascular Interventions 15 (2022): 1770–1772.
10.1016/j.jcin.2022.06.032
PubMed Web of Science® Google Scholar
4P. Debonnaire, S. Droogmans, P. Coussement, et al., “A Breath of Air During MitraClip Valve Repair,” Acta Cardiologica 75 (2020): 683–684.
10.1080/00015385.2019.1639938
PubMed Web of Science® Google Scholar
5F. Maisano, G. La Canna, A. Latib, et al., “Transseptal Access for MitraClip(R) Procedures Using Surgical Diathermy Under Echocardiographic Guidance,” EuroIntervention: Journal of EuroPCR in Collaboration With the Working Group on Interventional Cardiology of the European Society of Cardiology 8 (2012): 579–586.
10.4244/EIJV8I5A89
PubMed Web of Science® Google Scholar
6N. Nielsen, J. Baranowski, G. Boano, E. Nylander, and L. Wallby, “ Massive Air Embolism During MitraClip Insertion,” in Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair, eds. T. Feldman, O. Franzen, R. Low, J. Rogers, and K. Yeo (Springer, 2013), 519–520.
10.1007/978-1-4471-4294-2_40
Google Scholar
7D. Kaewkes, Y. Moshkovits, and M. Shenoda, “ Air Embolization During a MitraClip Procedure,” in Complex Cases in Structural Heart Intervention Switzerland, eds. O. Koren, R. Makkar, V. Patel, D. Kaewkes, H. Jilaihawi, and J. Joseph (Springer, 2023), 225–229.
10.1007/978-3-031-05965-0_27
Google Scholar
8S. Hadjadj, D. del Val, R. Robert, J. Beaudoin, J. Rodés-Cabau, and J. M. Paradis, “To Take One's Breath Away: Echocardiography-Guided Aspiration of an Air Embolism During a MitraClip Procedure,” CJC Open 3 (2021): 115–117.
10.1016/j.cjco.2020.08.010
PubMed Web of Science® Google Scholar
9K. Matsushita, M. Kibler, F. Zeyons, S. Hess, O. Morel, and P. Ohlmann, “Acute Right Ventricular Failure and Right-to-Left Shunt Due to Massive Coronary Air Embolism Following MitraClip,” Canadian Journal of Cardiology 38 (2022): 1318–1319.
10.1016/j.cjca.2022.02.012
PubMed Web of Science® Google Scholar
10L. Marcoff, “Large Air Embolism During Percutaneous Edge-to-Edge Mitral Valve Repair Detected by Intraprocedural TEE,” Transcatheter Valve Therapeutics (2017).
Google Scholar
11R. B. Tang, J. Z. Dong, D. Y. Long, et al., “Incidence and Clinical Characteristics of Transient ST-T Elevation During Transseptal Catheterization for Atrial Fibrillation Ablation,” Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology 17 (2015): 579–583.
10.1093/europace/euu278
PubMed Web of Science® Google Scholar
12N. Shaikh and F. Ummunisa, “Acute Management of Vascular Air Embolism,” Journal of Emergencies, Trauma, and Shock 2 (2009): 180–185.
10.4103/0974-2700.55330
PubMed Google Scholar
13A. L. Wellford, G. Lawrie, and W. A. Zoghbi, “Transesophageal Echocardiographic Features and Management of Retained Intracardiac Air in Two Patients After Surgery,” Journal of the American Society of Echocardiography 9 (1996): 182–186.
10.1016/S0894-7317(96)90026-7
CAS PubMed Google Scholar
14Y. Oka, K. Tsuzaki, M. Kamei, A. Kikuya, and T. Hamano, “Postoperative Cerebral Air Embolism With Delayed Abnormal Brain MRI Findings,” eNeurologicalSci 22 (2021): 100305.
10.1016/j.ensci.2020.100305
PubMed Google Scholar
15S. R. Thom, “Functional Inhibition of Leukocyte B2 Integrins by Hyperbaric Oxygen in Carbon Monoxide-Mediated Brain Injury in Rats,” Toxicology and Applied Pharmacology 123 (1993): 248–256.
10.1006/taap.1993.1243
CAS PubMed Web of Science® Google Scholar
16 Navy Department, “ US Navy Diving Manual.” Revision 6. Vol 5: Diving Medicine and Recompression Chamber Operations. NAVSEA 0910-LP-106-0957 (Naval Sea Systems Command, 2008).
Google Scholar
17R. A. Fakkert, N. Karlas, P. Schober, et al., “Early Hyperbaric Oxygen Therapy Is Associated With Favorable Outcome in Patients With Iatrogenic Cerebral Arterial Gas Embolism: Systematic Review and Individual Patient Data Meta-Analysis of Observational Studies,” Critical Care 27 (2023): 282.
10.1186/s13054-023-04563-x
PubMed Web of Science® Google Scholar

Volume106, Issue1

July 1, 2025

Pages 581-589

SCAI Member Sign in

Filename	Description
ccd31600-sup-0001-M1.mp44.9 MB	M1.
ccd31600-sup-0002-M2.mp44.2 MB	M2.
ccd31600-sup-0003-M3.mp4928.6 KB	M3.
ccd31600-sup-0004-M4.mp41.6 MB	M4.
ccd31600-sup-0005-M5.mp416.6 MB	M5.
ccd31600-sup-0006-M6.mp44.7 MB	M6.
ccd31600-sup-0007-M7.mp410.3 MB	M7.
ccd31600-sup-0008-M8.mp45 MB	M8.
ccd31600-sup-0009-M9.mp4837.4 KB	M9.
ccd31600-sup-0010-M10.mp42.8 MB	M10.
ccd31600-sup-0011-M11.mp49.6 MB	M11.
ccd31600-sup-0012-M12.mp41.6 MB	M12.
ccd31600-sup-0013-M13.mp41.5 MB	M13.

Arterial Gas Embolism During Mitral Transcatheter Edge-to-Edge Repair: Prevention, Management, and Treatment: Case Report and Review of the Literature

ABSTRACT

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Arterial Gas Embolism During Mitral Transcatheter Edge-to-Edge Repair: Prevention, Management, and Treatment: Case Report and Review of the Literature

ABSTRACT

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Related

Information