CASE DESCRIPTION
A 79-year-old female patient was diagnosed with osteoporotic vertebral
compression fracture and decided to undergo PVP surgery. Preoperative
echocardiography showed that the left ventricular ejection fraction was
62 %, the ascending aorta was dilated (which may be related to the
patient’s long-term hypertension), and the left ventricular diastolic
function was reduced. However, 14 hours after the operation, the patient
suddenly became unconscious after moving, vomited a small number of
stomach contents, urinated incontinence, and unable to move his limbs.
The doctor immediately gave oxygen inhalation and intravenous infusion.
Then the patient gradually became conscious and able to move his limbs,
but his blood pressure was unstable, with a minimum of 55/38 mmHg.
Emergency bedside echocardiography showed that the left ventricular
ejection fraction was 53 %, and the ventricular systolic function was
acceptable. A strong U-shaped echo with a length of about 6.5 cm can be
seen in the right ventricle, which is stored in the right ventricle
across the tricuspid valve (Fig. 1.A). A moderate regurgitation signal
can be seen in the tricuspid valve, and the pericardial effusion with a
depth of about 10mm can be seen in the pericardial cavity, the sound
transmission is poor. Combined with the history of PVP, the doctor
suspected that the patient might be a cardiogenic shock caused by the
bone cement in the heart. CT showed high density in the vertebral venous
plexus and the odd veins on the left side of the thoracic spine, and
there were multiple dots and high-density shadows in the distal branches
of both pulmonary arteries. It also indicated a high density in the
right atrium and hemopericardium (Fig. 2).
After the cardiac surgery consultation, the foreign body removal
operation under cardiopulmonary bypass was urgently performed. During
the operation, a block of U-shaped bone cement was found in the right
atrium (Fig. 3). The tip penetrated into the right ventricular wall
through the right ventricular side of the anterior valve of the
tricuspid valve, and the caudal end was located in the right atrium. The
bone cement was taken out and sutured to repair the wall of the right
ventricle. Exploration revealed that part of the chordae of the
posterior leaflet of the tricuspid valve was ruptured, so a tricuspid
valve repair was performed. The patient was discharged smoothly after 25
days of recovery. The echocardiogram before discharge showed mild
tricuspid regurgitation and mitral regurgitation, the pericardial
effusion was not detected (Fig. 1. B and C). One month later, the
echocardiography was rechecked, and there were no obvious other
abnormalities.