A Case Report Describing the Surgical Removal of Venous and Intracardiac Cement Leakage after Percutaneous Vertebroplasty in a Hybrid Operating Room

Abstract

AIM: Percutaneous vertebroplasty is generally considered a safe procedure, however, cases of cardioembolism and cardiac perforation have been reported. 

CASE PRESENTATION: A 69-year-old woman was referred to our emergency department after an outpatient echocardiogram revealed a “thrombus-like” formation involving the right heart. Two weeks before she had undergone percutaneous vertebroplasty of the third to fifth lumbar vertebrae due to osteoporotic fractures. She presented with palpitations. Further investigations revealed polymethyl methacrylate leakage involving the inferior vena cava, the right atrium, and the right ventricle in the total. 

RESULTS: Although the patient was clinically and hemodynamically stable, decisions about the timing and the specific technique for surgical removal of the foreign body were challenging. Considerable multidisciplinary teamwork involving cardiologists, cardiac surgeons, anesthetists, and bioengineer specialists of the bone cement was necessary due to the extension of the consolidated leakage. 

CONCLUSIONS: Through a combined approach with sternotomy and fluoroscopic guidance, it was possible to remove the foreign body without intraoperative complications. The patient recovered and returned to her normal life, following cardiac and physical rehabilitation.