Paradoxical carbon dioxide embolism through an iatrogenic atrial septal defect after catheter ablation for atrial fibrillation during laparoscopic hepatectomy: two case reports and a brief review of the literature (with video)

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发表日期：

2025年8月5日

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Yu Saito,
Yuji Morine,
Shinichiro Yamada,
Hiroki Teraoku,
Tetsuya Ikemoto,
Mitsuo Shimada

摘要

Carbon dioxide (CO₂) embolism is an intraoperative complication during laparoscopic hepatectomy (Hx). Paradoxical CO₂ embolism with right-to-left systemic shunting can cause cerebral infarction. Iatrogenic atrial septal defect (IASD) can occur after catheter ablation (CA) for atrial fibrillation (AF), and patients with IASD are at risk of paradoxical CO₂ embolism. The present case report described two CO₂ embolism cases during laparoscopic Hx after CA for Af (one is a paradoxical CO₂ embolism). Intraoperative transesophageal echocardiography (TEE) is required for quick identification of CO₂ embolism, and the procedure should be converted to laparotomy when paradoxical CO₂ embolism occurs. Those patients were fortunately discharged without any postoperative morbidity. CA for AF may increase the risk of paradoxical CO₂ embolism. The indication for laparoscopic Hx should be carefully judged based on the surgical procedure and the findings of preoperative TEE. Intraoperative TEE may be beneficial for early detection for quick identification of CO₂ embolism, and the procedure should be converted to laparotomy when paradoxical CO₂ embolism occurs.