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Cardiac Embolism Followed by Perforation of Right Ventricle after Percutaneous Vertebroplasty.
Kyoung-Mo KIM, Sang-Hyun Kim, Chang-Yong Park
Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
Correspondence  Sang-Hyun Kim ,Tel: +82-01-9975-0774, Fax: +82-31-219-5238, Email: shkim709@aumc.ac.kr
Received: August 19, 2018;  Accepted: September 14, 2018.  Published online: September 14, 2018.
The incidence of osteoporotic or neoplastic vertebral compression fractures is increasing.Percutaneous vertebroplasty (PVP) is a minimally invasive procedure which is widely used for the treatment of pain due to vertebral compression fractures. Mechanical stabilization of the fracture segment and significant reduction of pain can be achieved after PVP using polymethylmethacrylate (PMMA). . However, bone cement leakage into the paravertebral venous system can rarely lead to systemic complications such as pulmonary embolism and even worse, intracardiac injury. A 49-year-old male was admitted with the chest pain, dyspnea. During hemodialysis blood pressure drop occurred with the symptoms. He received PVP in local hospital for L5 compression fracture 4 days ago. Chest X-ray and computerized tomography (CT) showed a rod shaped high-density material positioning through right atrium (RA) and right ventricle (RV). Emergency pericardiocentesis was done for the removal of foreign body and repair of the ruptured RV wall. Intracardiac bone cement embolism is not a common complication, but the number of PVP cases is growing, and it is possible that intracardiac cement will not be so rare in the future. To prevent complications, small amount of PMMA should be injected slowly, and low viscosity PMMA should be avoided. Surgical removal is recommended for the patient with fatal symptomatic complications occur.
Key words: percutaneous vertebroplasty; cardiac embolism; compression fracture; polymethylmethacrylate
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Related article
Cardiac Embolism Followed by Perforation of Right Ventricle after Percutaneous Vertebroplasty  2018 October;4(2)
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