Removal of intracardiac bone cement embolism after percutaneous kyphoplasty

Abstract

Rationale: Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart. Patient concerns: A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty. Diagnoses: Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found. Interventions: The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve. Outcomes: The postoperative course was uneventful and the patient was discharged on the 13th day after surgery. Lessons: If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.

Bedside echocardiography for diagnosis of intracardiac cement embolism after percutaneous vertebroplasty: A case report

“…This case suggests that when sudden loss of consciousness or other atypical symptoms occur after PVP, echocardiography should be performed as soon as possible to evaluate the cardiac status, which is consistent with the view of Song et al 5 …”

“…Considering the length and location of the cement and the perforation of the heart due to the cement leakage, we performed a ruptured heart repair and tricuspid annuloplasty in this patient. This case suggests that when sudden loss of consciousness or other atypical symptoms occur after PVP, echocardiography should be performed as soon as possible to evaluate the cardiac status, which is consistent with the view of Song et al 5…”

Bedside echocardiography for diagnosis of Intracardiac cement embolism after percutaneous vertebroplasty: A case report

“…Previous studies have found that most patients with ICE have dyspnea or chest pain as the first symptoms after PVP, [5][6][7][8] the duration of onset is inconsistent, and rare cases may be asymptomatic. 6 But no matter what the clinical symptoms are, the most urgent need is for early detection and immediate treatment.…”

“…Xray has special advantages for the discovery of metallic foreign bodies, but it can usually not determine the specific location of the mass in the heart cavity, and some chest X-rays only show thickening of lung texture. 8 Chest CT can confirm the location of cement emboli in the heart, and at the same time can judge whether there is pulmonary embolism, 5,7-8 but it takes a long time for the examination and the results to be obtained, and it is impossible to observe the immediate changes of the foreign body.…”

A spear to the heart—the accidental discovery of a giant cement embolism in the right heart: a case report

“… 2 During the embolization, the cement migrates through the paravertebral or epidural veins into the venous system and embolizes in the direction of the right heart or pulmonary arteries. 3 Even if cement embolization is often asymptomatic, there is a risk of a fulminant course. Several risk factors have been identified for the occurrence of a cement embolism.…”