Krithika Ramaprabhu, Geske Jeffrey B, Villarraga Hector R, Crestanello Juan
Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester 55905, MN, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Eur Heart J Case Rep. 2022 Sep 16;6(10):ytac386. doi: 10.1093/ehjcr/ytac386. eCollection 2022 Oct.
The literature describing the complications following kyphoplasty is limited. This case report is a reminder that novel therapeutic strategies can be associated with unexpected complications.
A 61-year-old woman with rheumatoid arthritis and degenerative lumbar disc disease underwent open posterior instrumented fusion with bilateral open L2 vertebroplasty elsewhere. A month after discharge, she presented to our institution with acute chest pain and dyspnoea. A subsequent gated cardiac computed tomography (CT) angiogram showed three distinct cardiopulmonary emboli. One of the cement fragments had perforated the inferior wall of the right ventricle close to the base of the posterior tricuspid valve leaflet with a moderate circumferential pericardial effusion. Operative extraction of multiple cement emboli as well as repair of the tricuspid valve was pursued. Postoperative echocardiogram showed trivial tricuspid regurgitation after repair. The patient had an uneventful postoperative course and was discharged from the hospital on postoperative Day 5.
Cement embolization following kyphoplasty can be associated with serious complications such as vascular injury, hypoxaemia, pulmonary artery obstruction, and cardiac perforation. Clinicians must maintain a high index of suspicion as cement embolism may not always present acutely.
描述椎体后凸成形术后并发症的文献有限。本病例报告提醒我们，新的治疗策略可能会伴有意想不到的并发症。
一名61岁患有类风湿性关节炎和退行性腰椎间盘疾病的女性，在其他地方接受了后路切开内固定融合术及双侧L2椎体切开成形术。出院一个月后，她因急性胸痛和呼吸困难前来我院就诊。随后的门控心脏计算机断层扫描（CT）血管造影显示有三个不同的心肺栓子。其中一个骨水泥碎片穿透了右心室下壁，靠近三尖瓣后叶瓣叶基部，伴有中度心包积液。遂进行了多个骨水泥栓子的手术取出以及三尖瓣修复。术后超声心动图显示修复后三尖瓣有轻微反流。患者术后恢复顺利，术后第5天出院。
椎体后凸成形术后骨水泥栓塞可能会伴有严重并发症，如血管损伤、低氧血症、肺动脉阻塞和心脏穿孔。临床医生必须保持高度警惕，因为骨水泥栓塞可能并不总是急性发作。
