Transesophageal echocardiographic diagnosis of carbon dioxide embolism during minimally invasive saphenous vein harvesting and treatment with inhaled epoprostenol

G as embolism is a rare but potentially fatal complication of minimal access procedures in which carbon dioxide (CO2) is used. This complication occurred in approximately 1 of 7500 cases of laparoscopic surgery (1). Endoscopic saphenectomy is gaining popularity because it decreases morbidity compared with harvesting by the open technique (2,3) as well as improves functional and cosmetic appearance. Although safe, two cases of gas embolism during endoscopic saphenectomy have been published in the English literature (4,5). In one of these, the diagnosis was confirmed with intraoperative transesophageal. echocardiography (TEE). In this case report, we describe a case of CO2 embolism during endoscopic saphenectomy where TEE was used to confirm the diagnosis and evaluate the hemodynamic consequences and to assess the effectiveness of inhaled epoprostenol during this uncommon complication.