Ongoing paradoxical particulate embolism during megaprosthesis placement

Laudanski, Krzysztof; Patel, Samir P.; Peng, Yong G.

doi:10.1016/j.jclinane.2008.10.018

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 7 , Pages 533-537, November 2009

Ongoing paradoxical particulate embolism during megaprosthesis placement☆

Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA

Received 24 March 2008; received in revised form 19 September 2008; accepted 14 October 2008. published online 26 October 2009.

Series Editors: A. Joseph Layon, MD • Michael E. Mahla, MD Associate Series Editors: Lawrence Caruso, MD • Andrea Gabrielli, MD

Abstract

Pulmonary embolism (PE) by solid particles is an infrequent complication encountered during orthopedic procedures. A patent foramen ovale (PFO) allows embolic material into the left-sided circulation, potentially affecting several organs. A case of a 33-year-old woman undergoing total proximal femur resection with megaprosthesis reconstruction is presented. Towards the end of surgery, cement was injected to stabilize the prosthesis. Echodense particulate matter was first seen in the right atrium, subsequently in the right ventricle, and also in significant quantities in the left atrium and ventricle. This was accompanied by significant changes in partial pressure of arterial oxygen. Despite the aforementioned disturbances, hemodynamic stability was observed throughout the event. Postoperative follow-up showed persistent hypoxemia but no other abnormalities. This intriguing case of embolism via particulate material in a patient with PFO during hip replacement surgery allows review of the physiology and pathophysiology of PE phenomena.

Keywords: Femoral megaprosthesis, Paradoxical embolism, Patent foramen ovale, Pulmonary embolism, Transesophageal echocardiography