Air Embolism Resulting from Contrast Agent Injection During Coronary Computed Tomography: A Case Report 

Air Embolism Resulting from Contrast Agent Injection During Coronary Computed Tomography: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Air Embolism Resulting from Contrast Agent Injection During Coronary Computed Tomography: A Case Report Fangjing Xu, Hang Han, Zhi Chai, Yanxiang Yao, Yusheng Du, Li Jing, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8252660/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Air embolism is a rare but potentially lethal complication. Clinicians must recognize its warning signs and be ready to implement appropriate interventions. Early detection is crucial to reduce morbidity and mortality. This report presents a case of arterial air embolism following coronary computed tomography angiography. Case presentation A 60-year-old female developed air embolism due to contrast agent administration during a coronary CT study, presenting with shortness of breath and dizziness. Following treatment that included high-flow oxygen therapy (10 L/min), fluid resuscitation, and positioning in a supine position, her vital signs stabilized and arterial blood gas parameters returned to normal. A follow-up CT scan conducted 7 days later showed absorption of the air, leading to her discharge. Conclusion While rare, air embolism can cause mild symptoms with small volumes, but larger volumes may be life-threatening. Suspect air embolism in patients with neurological signs or sudden respiratory or cardiovascular symptoms, especially in the presence of risk factors. To minimize air entering the right ventricular outflow tract, prompt cessation of the embolism source, maintenance of a supine position, high-flow oxygen therapy, and hyperbaric oxygen treatment should be initiated. These timely interventions can prevent further complications and improve patient outcomes while reducing mortality. Trial registration This case report does not involve a clinical trial. air embolism angiography case report pulmonary artery ventilation Figures Figure 1 Figure 2 1. Introduction Air embolism is a pathological condition characterized by the obstruction of blood flow and tissue hypoxia, resulting from the entry of air into the vascular system. This clinical syndrome can lead to significant disturbances in the circulatory system, with rapid progression and a potentially critical outcome. The success rate of resuscitation in cases of air embolism is low, and the mortality rate is high. In clinical practice, air embolism can occur not only during angiography, needle aspiration biopsy, or pulmonary imaging in radiology, but also in various medical settings, such as during the insertion, use, and removal of central venous catheters and devices, as well as during trauma, surgery, and gynecological procedures. [ 1 – 2 ] Some literature reports that venous air embolism can occur actively during the pressure infusion of contrast agents [ 3 ] .Contrast agents are utilized in computed tomography (CT) scans to assist healthcare providers in obtaining clearer images. During such procedures, automatic high-pressure injection devices are employed for rapid contrast agent delivery, which may inadvertently introduce air into the venous circulation, resulting in air embolism. [ 4 ] It is essential for medical personnel to maintain a high level of vigilance regarding air embolism to ensure patient safety. Although typical presentations and clinical features of air embolism have been documented in the literature, there remains a lack of standardized diagnostic criteria, contributing to low incidence and diagnostic rates for this condition. Due to its rarity and potential lethality, air embolism poses significant challenges in clinical diagnosis. Many physicians may mistakenly diagnose or overlook pulmonary air embolism in patients presenting with atypical clinical manifestations, leading to delays in appropriate treatment and exacerbation of the condition. In this report, we present a case of a 60-year-old female who developed pulmonary artery air embolism following the injection of a contrast agent during a cardiac CT scan. The patient exhibited symptoms of dyspnea and dizziness but successfully received treatment and was discharged from the hospital. Timely and effective identification, diagnosis, and management of air embolism are crucial for improving patient prognosis and reducing mortality rates. 2. Case presentation A 60-year-old female patient was admitted to our hospital due to complaints of chest tightness and fatigue. The patient has a 15-year history of chronic obstructive pulmonary disease (COPD) and bronchial asthma, with a long-standing regimen of home oxygen therapy and nebulized medication.No history of alcohol or drug use was reported. Her Glasgow Coma Scale (GCS) was 15, vital signs included a blood pressure (BP) of 102/73 mmHg, a heart rate (HR) of 74 beats per minute, a respiratory rate (RR) of 18 breaths per minute, oxygen saturation (SaO2) of 95%, and a body temperature of 36.3°C. Physical examination revealed no significant abnormalities in the cardiopulmonary or neurological assessments.Laboratory investigations, including complete blood count, liver and kidney function tests, electrolyte levels, thyroid function tests, brain natriuretic peptide, cardiac enzymes, coagulation profile, and D-dimer assays, showed no remarkable abnormalities. An electrocardiogram (ECG) indicated sinus rhythm and ST-T changes with ST segment depression in leads II, III, and aVF. A preliminary diagnosis of coronary artery disease was made, and a contrast-enhanced coronary computed tomography (CT) scan was performed. A contrast agent (iohexol 37.5g/100ml) was administered via an automatic high-pressure injector into the antecubital vein. Following the contrast-enhanced CT scan, the patient developed mild dyspnea and dizzines. The CT findings revealed multiple air emboli in the right atrium, right ventricle, main pulmonary artery, and right pulmonary artery (Fig. 1 ). The patient was conscious and reported mild dizziness and shortness of breath upon assessment. Auscultation of the lungs revealed coarse breath sounds bilaterally, while heart sounds were normal with no significant murmurs detected. Vital signs at this time included a heart rate of 59 beats per minute, respiratory rate of 19 breaths per minute, blood pressure of 117/70 mmHg, and oxygen saturation of 100%. Arterial blood gas analysis indicated a pH of 7.37, a carbon dioxide partial pressure of 33.5 mmHg↓, an oxygen partial pressure of 92 mmHg, with an alveolar-arterial oxygen gradient of 15.85 mmHg↑. Further laboratory tests, including complete blood count, liver and kidney function, electrolyte levels, cardiac biomarkers, troponin tests, and D-dimer levels, showed no significant changes.Given the high risk of acute pulmonary air embolism in this patient, she was deemed critical and placed under continuous cardiac monitoring for 24 hours, receiving high-flow supplemental oxygen therapy, positioned in left lateral decubitus with the head down, alongside intravenous fluid administration and frequent blood gas monitoring. Treatment for her underlying conditions was continued.One week later, the patient was able to ambulate independently without supplemental oxygen, with a notable improvement in her symptoms of dizziness and shortness of breath. A follow-up pulmonary artery contrast-enhanced CT scan showed no abnormalities (Fig. 2 ). One month after discharge, a telephone follow-up with the patient revealed no complaints of discomfort. 3. Discussion VAE is a condition that arises from the entry of gas or air into the venous system, which subsequently may lead to the engagement of the right heart and pulmonary circulation. Generally, this condition is classified as an iatrogenic complication, often resulting from improper techniques during central venous catheter insertion, venous cannulation, or certain surgical procedures. Some literature indicates that VAE can occur proactively when intravenous contrast agents are injected under pressure, with approximately 23% of patients showing small amounts of air during such procedures. [ 5 – 6 ] However, there is currently no consensus regarding the correlation between the incidence of VAE and factors such as injection speed, injection site, volume or type of contrast agent, as well as the positioning, size, and nature of the intravenous catheter used. [ 7 ] It has been shown in the literature that this may be related to the presence of microbubbles in syringes, pressure tubes or contrast media. [ 8 ] VAE results from the entrance of air into the venous circulation, leading to retention in the right heart chambers and transit into the pulmonary circulation. The pulmonary tissue has a limited capacity to filter small bubbles from the venous circulation, meaning the impact of VAE depends on both the rate and volume of gas entry. Once the filtration capacity is exceeded, gas may traverse the pulmonary capillaries and enter the arterial circulation, potentially causing obstruction of blood flow to the heart, lungs, or other vital organs, which may result in ischemic or hypoxic lesions. The presence of bubbles not only affects hemodynamics but can also trigger a series of pro-coagulant processes, microcirculatory disturbances, and localized tissue damage. Additionally, bubbles can activate inflammatory responses in the body, precipitating a systemic immune reaction that may exacerbate the patient’s condition. Crucially, the volume and number of bubbles, the rate of entry, and the positioning of the patient can all significantly influence the pathophysiological responses to gas embolism. [ 9 – 11 ] The clinical symptoms and signs associated with air embolism are non-specific, with the severity of presentation influenced by the location of the embolism, the volume of gas, the velocity of the invasive procedure, individual patient variability, and the positioning of the patient at onset. Studies have indicated that for adult patients, a lethal volume of air may range from approximately 3 to 5 mL/kg, or a total volume of 200 to 300 mL. [ 12 ] In conscious patients, the primary symptoms may include, but are not limited to, dyspnea, chest pain, dizziness, loss of consciousness, limb numbness, nausea, vomiting, lethargy, and even seizures. The emergence of these symptoms is intricately linked to the behavior, size of bubbles within the bloodstream, and their impact on blood flow dynamics. [12.13] In non-conscious patients, clinical symptoms may be easily overlooked, underscoring the necessity for vigilant monitoring of vital signs. [14.15] The unique and characteristic sign of VAE is the presence of a “water-hammer” murmur, which is produced by the turbulence generated by gas and air within the cardiac chambers [ 16 ] . During surgical procedures or invasive examinations, if patients suddenly experience clinical symptoms such as chest pain and dyspnea, along with a decrease in blood pressure and oxygen saturation, as well as abrupt changes in heart rate (either increased or decreased) and arrhythmias, clinicians should maintain a heightened awareness of the potential occurrence of venous air embolism. Management of patients experiencing air embolism necessitates a timely and individualized approach, dependent on the size of the embolism and the clinical manifestations present. Interventions range from high-flow oxygen therapy and changes in patient positioning to more aggressive measures such as cardiac compression and large-bore airway suctioning. [ 17 , 18 , 19 ] Initially, patients should be placed in a left-lateral decubitus position with the head down, and instructed to hold their breath. [1.5] High-concentration oxygen therapy is crucial for alleviating hypoxia and facilitating bubble dissolution, as oxygenation can expedite the gas’s dissolution in the bloodstream. Hyperbaric oxygen therapy is recognized as one of the effective treatments for VAE, as it significantly enhances the solubility of gases, particularly in patients with severe bubble embolism. [1.8] In the current case, the patient’s clinical presentation was characterized by mild dizziness and shortness of breath, likely attributable to a limited volume of air and a minor area of embolization. Interventions including high-flow oxygen (10 L/min), fluid resuscitation, and supine positioning were administered. It is emphasized that prior to the injection of contrast media, it is essential to eliminate air from the syringe and pressure tubing to mitigate the risk of VAE. Following these therapeutic measures, follow-up pulmonary angiography one week later indicated significant resorption of gas from the right atrium, right ventricle, and pulmonary artery. The patient achieved successful treatment outcomes, with no residual effects noted on follow-up. 4. Conclusion In conclusion, air embolism represents a rare yet critical clinical condition, with its incidence having increased significantly due to advancements in medical technology and the rise of various invasive procedures. Thus, early detection and prevention are paramount. When patients present with neurological, respiratory, or cardiovascular symptoms in the context of known risk factors, air embolism should be suspected. Effective intervention strategies, including prompt cessation of the source of air embolism, appropriate positioning, high-flow oxygen therapy, and hyperbaric oxygen treatment, can not only prevent disease progression but also enhance patient outcomes and reduce mortality rates Declarations Author contribution statement Li Jing, Fangjing Xu, Yucheng Fan and Yusheng Du were actively involved in the conception and design of the study, the acquisition of data, and the analysis and interpretation of the results. Z.C., H.H. and Y.Y. contributed to the drafting of the manuscript and participated in the critical revision of the manuscript, ensuring its intellectual rigor. All authors had full access to the study data, collaborated throughout the research process, approved the final version of the manuscript for publication, and assume responsibility for the accuracy and integrity of the work. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. The patient was informed that anonymization could not be fully guaranteed and that the material may be publicly available online. A copy of the signed consent form is retained by the corresponding author and is available for review by the journal editorial team upon request. Funding This work was supported by Ningxia Natural Science Foundation (grant no. 2025AAC031002 to Y.F.), Ningxia Medical University Key Research Project (grant no. XZ2024040 to Y.F.), Ningxia Medical University General Research Project (grant no. XY2024138 to F.X.) and The 2024 Autonomous Region Youth Science and Technology Talent Development Project (Ningxia Association for Science and Technology [2025] No. 2). Author Contribution Li Jing, Fangjing Xu, Yucheng Fan and Yusheng Du were actively involved in the conception and design of the study, the acquisition of data, and the analysis and interpretation of the results. Z.C., H.H. and Y.Y. contributed to the drafting of the manuscript and participated in the critical revision of the manuscript, ensuring its intellectual rigor. All authors had full access to the study data, collaborated throughout the research process, approved the final version of the manuscript for publication, and assume responsibility for the accuracy and integrity of the work. References Lanfranco J, Romero Legro I, Freire AX, Nearing K, Ratnakant S. Pulmonary air embolism: An infrequent complication in the radiology suite [J]. Am J Case Rep. 2017;18:80–4. Uysal E, Alkan N, Cam B. A life-threatening condition: The pulmonary artery air embolism [J]. Turk J Emerg Med. 2019;19:157–9. Chang J, Casal R. Anesthetic management of gas embolism during rigid bronchoscopy with argon plasma coagulation: A case report [J]. AANA J. 2022;90:293–5. Abernathy CM, Dickinson TC. Massive air emboli from intravenous infusion pump: Etiology and prevention [J]. Am J Surg. 1979;137:274–5. Pham KL, Cohen AJ. Iatrogenic venous air embolism during contrast-enhanced computed tomography: A report of two cases [J]. Emerg Radiol. 2003;10:147–51. Cook LS. Infusion-related air embolism [J]. J Infus Nurs. 2013;36(1):26–36. Tufegdzic B, Lamperti M, Siyam A, Roser F. Air-embolism in the semi-sitting position for craniotomy: A narrative review with emphasis on a single center’s experience [J]. Clin Neurol Neurosurg. 2021;209:106904. Laasri K, Naggar A, Marrakchi S, El-Aoufir O, Laamrani FZ, Jroundi L. An unexpected complication: Air embolism during contrast-enhanced computed tomography [J]. Radiol Case Rep. 2023;19(3):953–5. Presson RG Jr, Kirk KR, Haselby KA, Linehan JH, Zaleski S, Wagner WW Jr. Fate of air emboli in the pulmonary circulation [J]. J Appl Physiol (1985), 1989, 67(5): 1898 – 902. Presson RG Jr, Kirk KR, Haselby KA, Wagner WW Jr. Effect of ventilation with soluble and diffusible gases on the size of air emboli [J]. J Appl Physiol (1985), 1991, 70(3): 1068-74. Loewenherz JW. Pathophysiology and treatment of decompression sickness and gas embolism [J]. J Fla Med Assoc. 1992;79(9):620–4. Toung TJ, Rossberg MI, Hutchins GM. Volume of air in a lethal venous air embolism [J]. Anesthesiology. 2001;94(2):360–1. Voigt P, Schob S, Gottschling S, Kahn T, Surov A. Systemic air embolism after endoscopy without vessel injury - A summary of reported cases [J]. J Neurol Sci. 2017;376:93–6. Dá Mesquita Faustino F, Costa AS, Ferreira I, Mendes JJ, Freitas P. An Unexpected Complication: Obstructive Shock Secondary to Venous Air Embolism [J]. Cureus. 2022;14(8):e27922. Brown AE, Rabinstein AA, Braksick SA. Clinical Characteristics, Imaging Findings, and Outcomes of Cerebral Air Embolism [J]. Neurocrit Care. 2023;38(1):158–64. Mitchell SJ, Bennett MH, Moon RE. Decompression Sickness and Arterial Gas Embolism [J]. N Engl J Med. 2022;386(13):1254–64. McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment [J]. J Clin Med. 2016;5(11):93. Lee JH, Yoon SH, Hong H, Rho JY, Goo JM. Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis [J]. Eur Radiol. 2021;31(4):2022–33. Altorbak NA, Daghistani RA, Al-Omaish HR, Alsaab TA, Alhomaiani SK. Pulmonary artery air embolism with consequent primary respiratory alkalosis and secondary metabolic alkalosis following ventilation therapy: A case report [J]. Med (Baltim). 2024;103(30):e39078. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Mar, 2026 Reviews received at journal 08 Feb, 2026 Reviews received at journal 07 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviews received at journal 31 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers invited by journal 29 Jan, 2026 Editor assigned by journal 09 Dec, 2025 Submission checks completed at journal 09 Dec, 2025 First submitted to journal 01 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8252660","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":583778015,"identity":"c87b1653-a37b-4acb-ad7c-f609beabd2e8","order_by":0,"name":"Fangjing Xu","email":"","orcid":"","institution":"Department of Emergency, The 942nd Hospital of the Joint Logistics Support Force, Chinese People’s Liberation Army","correspondingAuthor":false,"prefix":"","firstName":"Fangjing","middleName":"","lastName":"Xu","suffix":""},{"id":583778016,"identity":"de52714f-13e9-4de0-86b7-ccda55f58df5","order_by":1,"name":"Hang 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University","correspondingAuthor":false,"prefix":"","firstName":"Yanxiang","middleName":"","lastName":"Yao","suffix":""},{"id":583778019,"identity":"0e61ed84-e773-480b-93c3-c769f71f1c8b","order_by":4,"name":"Yusheng Du","email":"","orcid":"","institution":"Jiangxi Agricultural University","correspondingAuthor":false,"prefix":"","firstName":"Yusheng","middleName":"","lastName":"Du","suffix":""},{"id":583778020,"identity":"efe8a9b3-f1f4-4ce9-a3c5-65fc8dcb4b78","order_by":5,"name":"Li Jing","email":"","orcid":"","institution":"School of Basic Medical Science, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Jing","suffix":""},{"id":583778021,"identity":"5406a367-f813-4ff3-a196-0bab40a5c5ae","order_by":6,"name":"Yucheng Fan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIie3QMQrCMBSA4VcCuhS7pih6hZRCXUSv0tLVOorgUEGoixcQL5FN3Fo6dInOioseQFBwcHDwqYsgpHUTzA8PQuDjkQCoVD+ZjlPCKY8ABo+LGEhBoscA4jtC3YLEKK+SPfTb3sI8Jvskgnpl4xLrIiHmtOczWPveco4HJLaJxK9JCNvoDtUiEvBd16meI/A4kpRKSOdFwoBvRfOKW8JcwuiTpAFHC0hchsQ7SQgVXRvfkoUcDzReU2smDmNbIsCYCAt/bGizTFinuN9qVDI/Na8yg5Hb21YcbUT0HPKZlrdFpVKp/qo7PNpPPYDNyFQAAAAASUVORK5CYII=","orcid":"","institution":"Department of Pathology, The First People’s Hospital of Shizuishan, Affiliated to Ningxia Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yucheng","middleName":"","lastName":"Fan","suffix":""}],"badges":[],"createdAt":"2025-12-01 16:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8252660/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8252660/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101786938,"identity":"3e67045b-9363-432d-86be-59974526df8f","added_by":"auto","created_at":"2026-02-03 15:44:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136276,"visible":true,"origin":"","legend":"\u003cp\u003eAxial contrast-enhanced chest computed tomography image demonstrating air bubbles within the main pulmonary artery, right atrium, and right ventricle (arrows).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8252660/v1/8b6e35fba877a2a9f924fb6e.png"},{"id":101786937,"identity":"d7e3720f-2a36-4548-83ad-ef3dd909027e","added_by":"auto","created_at":"2026-02-03 15:44:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":152045,"visible":true,"origin":"","legend":"\u003cp\u003eContrast-enhanced chest computed tomography images showing no significant abnormalities (A、B).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8252660/v1/fe9b810e26b6c0091484eb86.png"},{"id":101786986,"identity":"3c97c0e9-d4c9-4090-bb9f-8c810f12403e","added_by":"auto","created_at":"2026-02-03 15:44:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":740024,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8252660/v1/3ef153a8-f465-410e-92d0-bae95e48b705.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Air Embolism Resulting from Contrast Agent Injection During Coronary Computed Tomography: A Case Report ","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAir embolism is a pathological condition characterized by the obstruction of blood flow and tissue hypoxia, resulting from the entry of air into the vascular system. This clinical syndrome can lead to significant disturbances in the circulatory system, with rapid progression and a potentially critical outcome. The success rate of resuscitation in cases of air embolism is low, and the mortality rate is high. In clinical practice, air embolism can occur not only during angiography, needle aspiration biopsy, or pulmonary imaging in radiology, but also in various medical settings, such as during the insertion, use, and removal of central venous catheters and devices, as well as during trauma, surgery, and gynecological procedures.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Some literature reports that venous air embolism can occur actively during the pressure infusion of contrast agents \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.Contrast agents are utilized in computed tomography (CT) scans to assist healthcare providers in obtaining clearer images. During such procedures, automatic high-pressure injection devices are employed for rapid contrast agent delivery, which may inadvertently introduce air into the venous circulation, resulting in air embolism. \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e It is essential for medical personnel to maintain a high level of vigilance regarding air embolism to ensure patient safety. Although typical presentations and clinical features of air embolism have been documented in the literature, there remains a lack of standardized diagnostic criteria, contributing to low incidence and diagnostic rates for this condition. Due to its rarity and potential lethality, air embolism poses significant challenges in clinical diagnosis. Many physicians may mistakenly diagnose or overlook pulmonary air embolism in patients presenting with atypical clinical manifestations, leading to delays in appropriate treatment and exacerbation of the condition.\u003c/p\u003e \u003cp\u003eIn this report, we present a case of a 60-year-old female who developed pulmonary artery air embolism following the injection of a contrast agent during a cardiac CT scan. The patient exhibited symptoms of dyspnea and dizziness but successfully received treatment and was discharged from the hospital. Timely and effective identification, diagnosis, and management of air embolism are crucial for improving patient prognosis and reducing mortality rates.\u003c/p\u003e"},{"header":"2. Case presentation","content":"\u003cp\u003eA 60-year-old female patient was admitted to our hospital due to complaints of chest tightness and fatigue. The patient has a 15-year history of chronic obstructive pulmonary disease (COPD) and bronchial asthma, with a long-standing regimen of home oxygen therapy and nebulized medication.No history of alcohol or drug use was reported. Her Glasgow Coma Scale (GCS) was 15, vital signs included a blood pressure (BP) of 102/73 mmHg, a heart rate (HR) of 74 beats per minute, a respiratory rate (RR) of 18 breaths per minute, oxygen saturation (SaO2) of 95%, and a body temperature of 36.3\u0026deg;C. Physical examination revealed no significant abnormalities in the cardiopulmonary or neurological assessments.Laboratory investigations, including complete blood count, liver and kidney function tests, electrolyte levels, thyroid function tests, brain natriuretic peptide, cardiac enzymes, coagulation profile, and D-dimer assays, showed no remarkable abnormalities. An electrocardiogram (ECG) indicated sinus rhythm and ST-T changes with ST segment depression in leads II, III, and aVF. A preliminary diagnosis of coronary artery disease was made, and a contrast-enhanced coronary computed tomography (CT) scan was performed. A contrast agent (iohexol 37.5g/100ml) was administered via an automatic high-pressure injector into the antecubital vein. Following the contrast-enhanced CT scan, the patient developed mild dyspnea and dizzines.\u003c/p\u003e \u003cp\u003eThe CT findings revealed multiple air emboli in the right atrium, right ventricle, main pulmonary artery, and right pulmonary artery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The patient was conscious and reported mild dizziness and shortness of breath upon assessment. Auscultation of the lungs revealed coarse breath sounds bilaterally, while heart sounds were normal with no significant murmurs detected. Vital signs at this time included a heart rate of 59 beats per minute, respiratory rate of 19 breaths per minute, blood pressure of 117/70 mmHg, and oxygen saturation of 100%. Arterial blood gas analysis indicated a pH of 7.37, a carbon dioxide partial pressure of 33.5 mmHg\u0026darr;, an oxygen partial pressure of 92 mmHg, with an alveolar-arterial oxygen gradient of 15.85 mmHg\u0026uarr;. Further laboratory tests, including complete blood count, liver and kidney function, electrolyte levels, cardiac biomarkers, troponin tests, and D-dimer levels, showed no significant changes.Given the high risk of acute pulmonary air embolism in this patient, she was deemed critical and placed under continuous cardiac monitoring for 24 hours, receiving high-flow supplemental oxygen therapy, positioned in left lateral decubitus with the head down, alongside intravenous fluid administration and frequent blood gas monitoring. Treatment for her underlying conditions was continued.One week later, the patient was able to ambulate independently without supplemental oxygen, with a notable improvement in her symptoms of dizziness and shortness of breath. A follow-up pulmonary artery contrast-enhanced CT scan showed no abnormalities (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). One month after discharge, a telephone follow-up with the patient revealed no complaints of discomfort.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eVAE is a condition that arises from the entry of gas or air into the venous system, which subsequently may lead to the engagement of the right heart and pulmonary circulation. Generally, this condition is classified as an iatrogenic complication, often resulting from improper techniques during central venous catheter insertion, venous cannulation, or certain surgical procedures. Some literature indicates that VAE can occur proactively when intravenous contrast agents are injected under pressure, with approximately 23% of patients showing small amounts of air during such procedures. \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e However, there is currently no consensus regarding the correlation between the incidence of VAE and factors such as injection speed, injection site, volume or type of contrast agent, as well as the positioning, size, and nature of the intravenous catheter used. \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e It has been shown in the literature that this may be related to the presence of microbubbles in syringes, pressure tubes or contrast media. \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVAE results from the entrance of air into the venous circulation, leading to retention in the right heart chambers and transit into the pulmonary circulation. The pulmonary tissue has a limited capacity to filter small bubbles from the venous circulation, meaning the impact of VAE depends on both the rate and volume of gas entry. Once the filtration capacity is exceeded, gas may traverse the pulmonary capillaries and enter the arterial circulation, potentially causing obstruction of blood flow to the heart, lungs, or other vital organs, which may result in ischemic or hypoxic lesions. The presence of bubbles not only affects hemodynamics but can also trigger a series of pro-coagulant processes, microcirculatory disturbances, and localized tissue damage. Additionally, bubbles can activate inflammatory responses in the body, precipitating a systemic immune reaction that may exacerbate the patient\u0026rsquo;s condition. Crucially, the volume and number of bubbles, the rate of entry, and the positioning of the patient can all significantly influence the pathophysiological responses to gas embolism. \u003csup\u003e[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe clinical symptoms and signs associated with air embolism are non-specific, with the severity of presentation influenced by the location of the embolism, the volume of gas, the velocity of the invasive procedure, individual patient variability, and the positioning of the patient at onset. Studies have indicated that for adult patients, a lethal volume of air may range from approximately 3 to 5 mL/kg, or a total volume of 200 to 300 mL. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e In conscious patients, the primary symptoms may include, but are not limited to, dyspnea, chest pain, dizziness, loss of consciousness, limb numbness, nausea, vomiting, lethargy, and even seizures. The emergence of these symptoms is intricately linked to the behavior, size of bubbles within the bloodstream, and their impact on blood flow dynamics. \u003csup\u003e[12.13]\u003c/sup\u003e In non-conscious patients, clinical symptoms may be easily overlooked, underscoring the necessity for vigilant monitoring of vital signs. \u003csup\u003e[14.15]\u003c/sup\u003e The unique and characteristic sign of VAE is the presence of a \u0026ldquo;water-hammer\u0026rdquo; murmur, which is produced by the turbulence generated by gas and air within the cardiac chambers \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. During surgical procedures or invasive examinations, if patients suddenly experience clinical symptoms such as chest pain and dyspnea, along with a decrease in blood pressure and oxygen saturation, as well as abrupt changes in heart rate (either increased or decreased) and arrhythmias, clinicians should maintain a heightened awareness of the potential occurrence of venous air embolism.\u003c/p\u003e \u003cp\u003eManagement of patients experiencing air embolism necessitates a timely and individualized approach, dependent on the size of the embolism and the clinical manifestations present. Interventions range from high-flow oxygen therapy and changes in patient positioning to more aggressive measures such as cardiac compression and large-bore airway suctioning. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e Initially, patients should be placed in a left-lateral decubitus position with the head down, and instructed to hold their breath. \u003csup\u003e[1.5]\u003c/sup\u003eHigh-concentration oxygen therapy is crucial for alleviating hypoxia and facilitating bubble dissolution, as oxygenation can expedite the gas\u0026rsquo;s dissolution in the bloodstream. Hyperbaric oxygen therapy is recognized as one of the effective treatments for VAE, as it significantly enhances the solubility of gases, particularly in patients with severe bubble embolism. \u003csup\u003e[1.8]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the current case, the patient\u0026rsquo;s clinical presentation was characterized by mild dizziness and shortness of breath, likely attributable to a limited volume of air and a minor area of embolization. Interventions including high-flow oxygen (10 L/min), fluid resuscitation, and supine positioning were administered. It is emphasized that prior to the injection of contrast media, it is essential to eliminate air from the syringe and pressure tubing to mitigate the risk of VAE. Following these therapeutic measures, follow-up pulmonary angiography one week later indicated significant resorption of gas from the right atrium, right ventricle, and pulmonary artery. The patient achieved successful treatment outcomes, with no residual effects noted on follow-up.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eIn conclusion, air embolism represents a rare yet critical clinical condition, with its incidence having increased significantly due to advancements in medical technology and the rise of various invasive procedures. Thus, early detection and prevention are paramount. When patients present with neurological, respiratory, or cardiovascular symptoms in the context of known risk factors, air embolism should be suspected. Effective intervention strategies, including prompt cessation of the source of air embolism, appropriate positioning, high-flow oxygen therapy, and hyperbaric oxygen treatment, can not only prevent disease progression but also enhance patient outcomes and reduce mortality rates\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eAuthor contribution statement\u003c/h2\u003e \u003cp\u003eLi Jing, Fangjing Xu, Yucheng Fan and Yusheng Du were actively involved in the conception and design of the study, the acquisition of data, and the analysis and interpretation of the results. Z.C., H.H. and Y.Y. contributed to the drafting of the manuscript and participated in the critical revision of the manuscript, ensuring its intellectual rigor. All authors had full access to the study data, collaborated throughout the research process, approved the final version of the manuscript for publication, and assume responsibility for the accuracy and integrity of the work.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003e Written informed consent was obtained from the patient for publication of this case report and any accompanying images. The patient was informed that anonymization could not be fully guaranteed and that the material may be publicly available online. A copy of the signed consent form is retained by the corresponding author and is available for review by the journal editorial team upon request.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by Ningxia Natural Science Foundation (grant no. 2025AAC031002 to Y.F.), Ningxia Medical University Key Research Project (grant no. XZ2024040 to Y.F.), Ningxia Medical University General Research Project (grant no. XY2024138 to F.X.) and The 2024 Autonomous Region Youth Science and Technology Talent Development Project (Ningxia Association for Science and Technology [2025] No. 2).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLi Jing, Fangjing Xu, Yucheng Fan and Yusheng Du were actively involved in the conception and design of the study, the acquisition of data, and the analysis and interpretation of the results. Z.C., H.H. and Y.Y. contributed to the drafting of the manuscript and participated in the critical revision of the manuscript, ensuring its intellectual rigor. All authors had full access to the study data, collaborated throughout the research process, approved the final version of the manuscript for publication, and assume responsibility for the accuracy and integrity of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLanfranco J, Romero Legro I, Freire AX, Nearing K, Ratnakant S. Pulmonary air embolism: An infrequent complication in the radiology suite [J]. Am J Case Rep. 2017;18:80\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUysal E, Alkan N, Cam B. A life-threatening condition: The pulmonary artery air embolism [J]. Turk J Emerg Med. 2019;19:157\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang J, Casal R. Anesthetic management of gas embolism during rigid bronchoscopy with argon plasma coagulation: A case report [J]. AANA J. 2022;90:293\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbernathy CM, Dickinson TC. Massive air emboli from intravenous infusion pump: Etiology and prevention [J]. Am J Surg. 1979;137:274\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePham KL, Cohen AJ. Iatrogenic venous air embolism during contrast-enhanced computed tomography: A report of two cases [J]. Emerg Radiol. 2003;10:147\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook LS. Infusion-related air embolism [J]. J Infus Nurs. 2013;36(1):26\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTufegdzic B, Lamperti M, Siyam A, Roser F. Air-embolism in the semi-sitting position for craniotomy: A narrative review with emphasis on a single center\u0026rsquo;s experience [J]. Clin Neurol Neurosurg. 2021;209:106904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaasri K, Naggar A, Marrakchi S, El-Aoufir O, Laamrani FZ, Jroundi L. An unexpected complication: Air embolism during contrast-enhanced computed tomography [J]. Radiol Case Rep. 2023;19(3):953\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePresson RG Jr, Kirk KR, Haselby KA, Linehan JH, Zaleski S, Wagner WW Jr. Fate of air emboli in the pulmonary circulation [J]. \u003cem\u003eJ Appl Physiol\u003c/em\u003e (1985), 1989, 67(5): 1898\u0026thinsp;\u0026ndash;\u0026thinsp;902.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePresson RG Jr, Kirk KR, Haselby KA, Wagner WW Jr. Effect of ventilation with soluble and diffusible gases on the size of air emboli [J]. \u003cem\u003eJ Appl Physiol\u003c/em\u003e (1985), 1991, 70(3): 1068-74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoewenherz JW. Pathophysiology and treatment of decompression sickness and gas embolism [J]. J Fla Med Assoc. 1992;79(9):620\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToung TJ, Rossberg MI, Hutchins GM. Volume of air in a lethal venous air embolism [J]. Anesthesiology. 2001;94(2):360\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoigt P, Schob S, Gottschling S, Kahn T, Surov A. Systemic air embolism after endoscopy without vessel injury - A summary of reported cases [J]. J Neurol Sci. 2017;376:93\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026aacute; Mesquita Faustino F, Costa AS, Ferreira I, Mendes JJ, Freitas P. An Unexpected Complication: Obstructive Shock Secondary to Venous Air Embolism [J]. Cureus. 2022;14(8):e27922.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown AE, Rabinstein AA, Braksick SA. Clinical Characteristics, Imaging Findings, and Outcomes of Cerebral Air Embolism [J]. Neurocrit Care. 2023;38(1):158\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchell SJ, Bennett MH, Moon RE. Decompression Sickness and Arterial Gas Embolism [J]. N Engl J Med. 2022;386(13):1254\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment [J]. J Clin Med. 2016;5(11):93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JH, Yoon SH, Hong H, Rho JY, Goo JM. Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis [J]. Eur Radiol. 2021;31(4):2022\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltorbak NA, Daghistani RA, Al-Omaish HR, Alsaab TA, Alhomaiani SK. Pulmonary artery air embolism with consequent primary respiratory alkalosis and secondary metabolic alkalosis following ventilation therapy: A case report [J]. Med (Baltim). 2024;103(30):e39078.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"air embolism, angiography, case report, pulmonary artery, ventilation","lastPublishedDoi":"10.21203/rs.3.rs-8252660/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8252660/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAir embolism is a rare but potentially lethal complication. Clinicians must recognize its warning signs and be ready to implement appropriate interventions. Early detection is crucial to reduce morbidity and mortality. This report presents a case of arterial air embolism following coronary computed tomography angiography.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 60-year-old female developed air embolism due to contrast agent administration during a coronary CT study, presenting with shortness of breath and dizziness. Following treatment that included high-flow oxygen therapy (10 L/min), fluid resuscitation, and positioning in a supine position, her vital signs stabilized and arterial blood gas parameters returned to normal. A follow-up CT scan conducted 7 days later showed absorption of the air, leading to her discharge.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile rare, air embolism can cause mild symptoms with small volumes, but larger volumes may be life-threatening. Suspect air embolism in patients with neurological signs or sudden respiratory or cardiovascular symptoms, especially in the presence of risk factors. To minimize air entering the right ventricular outflow tract, prompt cessation of the embolism source, maintenance of a supine position, high-flow oxygen therapy, and hyperbaric oxygen treatment should be initiated. These timely interventions can prevent further complications and improve patient outcomes while reducing mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case report does not involve a clinical trial.\u003c/p\u003e","manuscriptTitle":"Air Embolism Resulting from Contrast Agent Injection During Coronary Computed Tomography: A Case Report ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:44:27","doi":"10.21203/rs.3.rs-8252660/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-20T12:40:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T08:37:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T04:08:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214042388099897515631768001461403980276","date":"2026-02-01T09:18:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-31T12:31:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266170703441491026959726536199932409597","date":"2026-01-30T16:57:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79597277118037434392142377190138910986","date":"2026-01-30T12:40:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237106235169788291649528494373552919251","date":"2026-01-29T12:46:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T10:17:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-10T04:51:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-10T04:50:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-12-01T16:33:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b6b7204-7fd2-4b16-ba87-67a4f590382b","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T15:08:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:44:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8252660","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8252660","identity":"rs-8252660","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}