3D Echocardiographic Diagnosis of Right Ventricular Perforation With Polymethylmethacrylate Particles After Vertebroplasty

Echocardiographic Diagnosis of Congenital Arterial Catheter Function Changes

Arterial catheter is physiological flow channel between pulmonary artery and descending aorta in fetal circulation. Most right heart blood flow through artery catheter into descending aorta during embryo period. Most term neonates are usually stopped after fetal delivery. Functional closure occurs in 48 h after birth, while 88% should be closed completely at 8 weeks after birth. There was no significant difference between PDA occlusion technique guided by transthoracic echocardiography and conventional funnel PDA closure rate, total closure rate, long term closure rate, pulmonary systolic pressure before surgery and pulmonary artery pressure difference before and after operation (P < 0.05). Conversely, under similar therapeutic effects, funnel type PDA closure guided by transthoracic echocardiography has advantages such as shorter anesthesia time, less total ray volume and contrast agent, lower hospitalization expense and fewer complications. Therefore, through transthoracic echocardiography guidance delivery of order vein approach interventional closure therapy funnel type PDA especially suitable for children, worthy of clinical application.

Cement-related embolism after lumbar vertebroplasty: A case report

BACKGROUND

Cement-related embolism is a rare but potentially fatal complication in spinal surgery. Cardiac echocardiography can provide valuable information for the early identification.

CASE SUMMARY

A 66-year-old woman who underwent lumbar vertebroplasty and internal fixation under general anesthesia experienced an episode of supraventricular tachycardia and ventricular tachycardia at the end of surgery. Point-of-care echocardiogram revealed a foreign body in the right heart. After conservative treatment in the intensive care unit, her family decided on comfort care and she expired.

CONCLUSION

Transthoracic echocardiography may provide early valuable information in patients undergoing vertebroplasty, and mild-moderate pericardial effusion may be a significant sign of a poor outcome.

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

Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized light.