Cardiac Perforation due to Intracardiac Bone Cement After Percutaneous Vertebroplasty

Abstract

A 68-year-old female presented with progressive dyspnea 28 days following a percutaneous vertebroplasty of the third lumbar vertebrae for chronic back pain. A chest radiograph, which was obtained on admission, showed a massive pleural effusion in the left lung field and multiple high-density tubular opacities corresponding to the course of the pulmonary vessels ( Fig. 1). Chest computed tomography (CT) revealed radio-opaque linear deposits in the right ventricle and distal branches of both pulmonary arteries. Thus, it was suspected that the metal-density materials, found in the right ventricle, had perforated the right ventricular-free wall and caused hemopericardium and hemothorax (Fig. 2). Figure 1. Chest radiography shows large hemothorax and high-density foreign body (arrow).

Cardiac Perforation Caused by Bone Cements as a Complication of Cement Augmented Pedicle Screw Fixation Using the Fenestrated Pedicle Screw: A Case Report

“…To our best acknowledge, all cardiac perforation after bone cement injection has happened in vertebroplasty, 10 11 15) and it could be caused by a sharp and large fragment of bone cement. The mechanism of cement leakage causing cardiac perforation has not been confirmed.…”

“… 4 8) Cement leakage can occur as a complication of cement augmentation and cause local complications and systemic complications such as cerebral embolism, cardiac embolism, pulmonary embolism, renal artery embolism, and acute respiratory distress syndrome. 2 6 7 10 11 13 14 15) The mechanisms of cement leakage have not been analyzed yet, but it could be estimated. First, the intravetebral cleft would be a tract of cement leakage.…”

“…However, cardiac perforation caused by a large bone cement fragment may have a differenct mechanism from other emboic complications. 10 11 15) …”

“… 8 9 12) This procedure is almost the same method as conventional vertebroplasty. Cardiac perforation after vertebroplasty is a very rare complication 10 11 15) and it would be caused by a sharp and large fragment of bone cement. The cause of cardiac perforation after vertebroplasty is not yet known, but several case reports assumed that cardiac perforation was caused by direct cement injection to the vena cava.…”

Fatal cardiac perforation and pulmonary embolism of leaked cement after percutaneous vertebroplasty

“…In a few cases, even small emboli may be lethal if they lodge in the right atrium or ventricle and cause cardiac perforation and cardiac tamponade rather than traveling to the pulmonary circulation. [21][22][23][24][25][26][27][28][29][30] Linear pieces of cement as small as 10-20 mm long have been reported to cause cardiac tamponade, and pieces as small as 20 mm have been reported to cause perforations of the right ventricle. It is not surprising that this complication can occur when we consider that all pulmonary emboli pass through the right-sided cardiac chambers.…”