Hyperbaric Oxygen Therapy for Air Embolism Stroke Post-Mitral Valve Repair

Critical Distinction: Air Embolism vs. Routine Ischemic Stroke

The American Heart Association/American Stroke Association recommends hyperbaric oxygen therapy (HBOT) for ischemic neurological symptoms secondary to air embolism, as stated in multiple guidelines 1, 2, 3, 4
The American Heart Association/American Stroke Association does not recommend HBOT for routine acute ischemic stroke (Class III: No Benefit), where clinical trials have been inconclusive or shown no improvement in outcomes 2, 4
The 2018 American Heart Association/American Stroke Association guidelines explicitly state that hyperbaric oxygen is not recommended for patients with acute ischemic stroke except when caused by air embolization 4

HBOT increases oxygen delivery to ischemic tissue by dramatically increasing dissolved oxygen in plasma (up to 100% oxygen at 1.5-3.0 atmospheres absolute) 2
The effects of HBOT are specific to gas emboli and explain why HBOT is standard treatment for decompression sickness and iatrogenic air embolism 1, 5

The American Heart Association/American Stroke Association recommends coordinating transfer to a hyperbaric facility immediately while stabilizing the patient with suspected air embolism stroke post-mitral valve repair 4

HBOT carries minimal risk in the context of air embolism stroke, with side effects generally limited to transient myopia, middle ear/sinus barotrauma, claustrophobia, and rarely seizures 2, 4

Air embolization is a recognized risk during mitral valve procedures, occurring from inadequate de-airing techniques, manipulation of delivery catheters, or device-related issues, according to Nature Reviews Cardiology 6

High clinical suspicion is warranted in any patient developing acute neurological deficits during or immediately after mitral valve repair, as stated in Nature Reviews Cardiology 6
Air embolism during transcatheter mitral procedures can originate from delivery systems, device components, or transseptal puncture sites, as noted in Nature Reviews Cardiology 6

Maintain adequate intraprocedural anticoagulation (activated clotting time 200-300 seconds) to minimize concurrent thrombus formation, as recommended by Nature Reviews Cardiology 7
Post-procedure anticoagulation decisions should follow standard protocols for the specific mitral intervention performed, according to Nature Reviews Cardiology 7
For transcatheter edge-to-edge repair (TEER), dual antiplatelet therapy for 1-6 months is typically recommended in OAC-naive patients, as suggested by Nature Reviews Cardiology 7