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.