Intracardiac cement embolism following vertebroplasty:A case report

Uysal H., Çolak A., Kumral Z., Turan O. E., Şimşek H. T., Barış M. M.

The International Academy of Young Cardiologists 2024, Girne, Kıbrıs (Kktc), 18 - 22 Eylül 2024, ss.1, (Tam Metin Bildiri)

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: Girne
  • Basıldığı Ülke: Kıbrıs (Kktc)
  • Sayfa Sayıları: ss.1
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Intracardiac cement embolism following vertebroplasty:A case report

Hacer Uysal1, Zeynep Kumral1, Ayşe Çolak1, Oğuzhan Ekrem Turan1, Mustafa Mahmut Barış2, Hüsna Tuğçe Şimşek1
1Dokuz Eylül Üniversitesi Tıp Fakültesi, Kardiyoloji Ana Bilim Dalı, İzmir
2Dokuz Eylül Üniversitesi Tıp Fakültesi, Radyoloji Ana Bilim Dalı, İzmir

Background: Percutaneous vertebroplasty (PVP) is a well-established procedure for the treatment of vertebral fractures. Complications such as migration of bone cement fragments through the paravertebral plexus and then the azygous venous system into the right-sided cardiac chambers are rare and detected in approximately 3.9% of the patients. Most of the cases were asymptomatic and only an incidentally detected finding, but symptomatic serious complications like valvular dysfunction, pulmonary artery obstruction, and life-threatening free wall cardiac rupture resulting in cardiac tamponade can occur in 0.3% of the patients. We present a case of intracardiac cement embolism after PVP and discuss the management of our patient.

Case summary: A 75-year-old male patient with a past medical history of heart failure with reduced ejection fraction (HFrEF), atrial fibrillation (AF) underwent fluoroscopy-guided L1 and L3 vertebroplasty. After 2 months after PVP patient applied to our hospital's arrhythmia clinic because of his bradycardia history, he had mild dyspnea as well. Transthoracic echocardiogram revealed oval, pouch-shaped structure with well-defined borders in the rvot(figure 1), cardiac CT scan was performed on the patient and compared with the previous CT scan, high density structure seen in the RVOT on cardiac CT angiogram was considered as inorganic material, and since it was not present on the preoperative CT (figure2), it was thought to be cement. The patient was also evaluated in the council with heart team; since patient is hemodynamically stable, no pericardial effusion, no gross valvular dysfunction or obstruction, it is decided conservative approach. Patient was already receiving anticoagulant treatment for AF (Rivoroksaban), his treatment was continued and close follow-up planned.

Conclusions: Intracardiac cement embolism is important complication after PVP. The majority of cases remain asymptomatic but may show symptoms after years later of the procedure. Symptomatic intracardiac cement embolisms have a low incidence (8.3% of patients with ICE). And these symptoms are most likely dyspnea and chest pain. Although rare, serious complications such as valve dysfunction and life-threatening cardiac tamponade have also been reported. As clinicians, we must be careful to keep in mind that this complications after PVP may occur.Routine thoracic CT scanning after PVP is recommended to reduce mortality and morbidity rates in the long term. There is no definitive treatment approach due to the small number of identified cases and the long-term results are still not fully known, treatment decisions are made considering patient characteristics and symptoms. Current treatment options are: conservative treatment includes symptomatic treatment and oral anticoagulant therapy for 3 to 6 months until PMMA endothelializes, and surgical treatment includes percutaneous embolectomy (especially for right atrial emboli) and open cardiac embolectomy.

Keywords: cement, intracardiac, embolism, case report, vertebroplasty

Fulltext / Presentation: File 0095 poster sunumu.pdf

figure 1

Transthoracic echocardiogram revealed floating oval foreign body in the right ventricle (red arrow)


figure 2

the picture on the left: There is no object in the right ventricle on the CT scan taken before PVP
the picture on the right: Cardiac CT angiogram depicted a high density foreign body in the RVOT (blue arrow); RCA,right coronory artery; RV,right ventricle; AO: Aorta