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CARDIAC SURGERY _____________________________________________________
Cardiac Perforation due to Intracardiac Bone Cement After Percutaneous Vertebroplasty Sang Pil Kim, M.D., Bong Soo Son, M.D., Sang Kwon Lee, M.D., and Do Hyung Kim, M.D. Department of Thoracic and Cardiovascular Surgery, Yangsan Hospital, Pusan National University, Yangsan, Gyeongsangnam-do, Republic of Korea doi: 10.1111/jocs.12270 (J Card Surg 2014;29:499–500) 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).
Conflict of interest: The authors have nothing to disclose and there is no conflict of interest. Address for correspondence: Do Hyung Kim, M.D., Department of Thoracic and Cardiovascular Surgery, Yangsan Hospital, Pusan National University, Beomeo-ri, Mulgeum-eup, Yangsan, Gyeongsangnam-do 626-770, Republic of Korea. Fax: þ82-55-360-2127; e-mail: [email protected]
KIM, ET AL. CARDIAC PERFORATION DUE TO BONE CEMENT
J CARD SURG 2014;29:499–500
Figure 2. Chest CT scan shows high-density cement material within the tricuspid valve and apical portion of right ventricle (arrow).
Cardiac surgery was performed through a median sternotomy. After aortic and bicaval cannulation was performed, the patient was placed on cardiopulmonary bypass. As the patient was being cooled, the right atrium was opened on the beating heart. A fishbone-like white cement material had impacted between the tricuspid valve and right ventricular apical-free wall, and had perforated both the right ventricular-free wall and pericardium, and the cement material was removed through the tricuspid valve (Fig. 3). The site of right ventricular rupture was directly repaired with simple suture of 4-0 prolene. The patient was discharged three days after the surgery.
Figure 3. Surgical specimen of cement material.