Cardiac arrest from massive carbon dioxide embolism during endoscopic saphenous vein harvesting

Endoscopic saphenous vein harvesting (EVH) is a safe, well-adopted standard minimally invasive vein harvesting procedure for coronary artery bypass grafting (CABG) surgery that requires carbon dioxide (CO2) inflation. CO2 embolism is a rare reported complication from EVH. If the amount of CO2 embolized is large, the situation can become be critical.1 Here, we present an educational case that highlights the life-threatening complication caused by EVH, CO2 embolus, which was treated successfully. The accompanying transesophageal echocardiogram (TEE) images describe the event process, showing the path of CO2 bubbles from the right heart to left heart through a patent foramen ovale (PFO).