Intracardiac Foreign Body (Bone Cement) after Percutaneous Vertebroplasty
A 65-year-old male was admitted to the emergency room with the chief complaint of epigastric pain and dyspnea that had started 10 days earlier. The patient had a history of undergoing percutaneous vertebroplasty (PV) in the third lumbar vertebra a month earlier, which was treated at a local clinic. A chest roentgenogram showed a long linear radio-opaque foreign body in the right ventricle (RV) and a shorter one in the pulmonary artery (). A computed tomography (CT) scan showed the foreign body in the RV, perforating the RV wall near the aortic root and just to the left lateral to the right coronary artery (), and a moderate quantity of hemopericardium was detected (). The cardiac echography findings showed hemopericardium and the foreign body, but no cardiac wall motion dysfunction or valvular dysfunction was seen. We planned open heart surgery for the removal of the bone cement. Sternotomy was performed in a routine fashion. When the pericardium was opened, a moderate amount of hemopericardium was evacuated (200 mL). The sharp end of the bone cement was perforating the RV wall as we expected (). By using bi-caval venous cannulation and single aortic cannulation, a cardiopulmonary bypass was conducted. The body temperature was lowered to mild hypothermia. The bone cement perforating the RV wall was embedded strongly. Right atriotomy was performed, and the tricuspid valve was checked and shown to be unharmed. Except for the perforated site, the RV showed no signs of injury. By retracting the tricuspid valve leaflet, the bone cement could be seen in the RV chamber. The foreign body was removed by delicately mobilizing the bone cement from inside of the RV chamber toward the outside (). The perforated site was repaired using a pledgeted Prolene suture. Total systemic circulatory arrest was performed for the removal of the bone cement in the left pulmonary artery, and the pulmonary trunk was opened. The bone cement was removed with biliary forceps in a blind manner (). After repair of the pulmonary artery, the body temperature was raised back to normal, and the patient was weaned from the cardiopulmonary bypass successfully. Postoperative recovery was uneventful and fast. On postoperative day 7, a follow-up CT scan, a chest roentgenogram, and cardiac echography were performed. The procedures showed no remnants of the foreign bodies () or functional disorder. The patient was discharged the next day.