Cardiac Perforation and Multiple Emboli After Percutaneous Vertebroplasty

Abstract

Percutaneous vertebroplasty is a minimally invasive technique for treating vertebral compression fractures and tumors. Although percutaneous vertebroplasty is considered a relatively safe and technically simple procedure, it is also associated with life-threatening complications as a result of cement leakage, including cardiac perforation and pulmonary embolism. A 63-year-old woman underwent percutaneous vertebroplasty for an L3 vertebral fracture and had cement leaks into the inferior vena cava, pulmonary arteries, and right heart chambers, with a free wall perforation. Surgical removal of the cement emboli was recommended as a result of apparent penetration of the ventricle and the fragile nature of polymethyl methacrylate. A cardiopulmonary bypass was immediately performed via a right atriotomy. A foreign body 10 cm in length was removed from the right atrium and ventricle. Arteriotomies were then performed, and 4 cement filaments were retrieved from the pulmonary arteries. The inferior vena cava was also surgically opened, allowing extraction of a cement fragment that was 12 cm long. The postoperative course was uneventful, and the patient fully recovered. This is the first report of the migration of a cement fragment larger than 10 cm that had migrated and embedded in the heart chamber. This report showed that imaging analysis is valuable when cement leakage is detected during percutaneous vertebroplasty and can be used to avoid serious complications and improve patient outcomes.

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

“… 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.…”

Pericardial tamponade during balloon pulmonary valvuloplasty in a dog

“…Even though PE is described as a rare complication in dogs undergoing balloon valvuloplasty, 36,37 cardiac perforation always must be taken into consideration as a possible complication. There are several case reports in humans 9,38 and even in dogs 13,19,39 reporting cardiac perforation during catheterisation with or without resulting PE. Iatrogenic perforation of the heart can lead to PE and pericardial tamponade.…”

“…6,7 Complications including hypotension, bradycardia, desaturation, ventricular arrhythmias, ventricular fibrillation, cardiopulmonary arrest and rupture of the balloon catheter have been reported during valvuloplasty in dogs. 8 Cardiac perforation has been reported as a possible but rare complication during balloon valvuloplasty in humans [9][10][11] ; however, to the authors' knowledge, cardiac perforation is reported even more rarely as a possible complication in dogs. 12,13 This case report describes an accidental cardiac perforation with resulting pericardial tamponade and cardiac arrest during advancement of the guiding wire for balloon valvuloplasty in a Coton de Tulear dog.…”

“Targeted Percutaneous Vertebroplasty” Versus Traditional Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture

“…The localization of puncture points of traditional PVP are not accurate enough, and various kinds of complications are reported now and then. 21,22 How to improve the precision and safety of puncture technology is the key factor to prevent complications from happening.…”