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Embolism detected by transoesophageal echocardiography during hip arthroplasty

  • Noëlle D. Lafont
  • Willy M. Kostucki
  • Philippe H. Marchand
  • Michel N. Michaux
  • Jean G. Boogaerts
Clinical Reports

Abstract

This case report demonstrates embolization of echogenic material detected by transoesophageal echocardiography during a cemented total hip arthroplasty in a 76- yr- old woman without patent foramen ovale. During the placement of the acetabular and femoral components, and during relocation of the hip joint, a “snow flurry” appearing in the right atrium was followed by several highly echogenic and mobile emboli of various sizes, some of them with a vermiform shape 1 to 5 cm long. At skin closure, echogenic material was seen in the right branch of the pulmonary artery adherent to the vascular wall of the bifurcation of the main pulmonary artery. No changes were observed in any haemodynamic variable monitored (heart rate, systemic and right atrial pressures). Also, no desaturation was detected by pulse oximetry and blood gases at the time of embolism and there was no decrease in PetCO2. This case report is in line with other studies which failed to show a haemodynamic impact of TEE detected emboli during THA.

Key words

complications: pulmonary embolism monitoring: echocardiography, transoesophageal surgery: orthopaedic 

Résumé

Ce cas clinique démontre l’embolisation de matériel échogène détecté par échocardiographie transoesophagienne (ETO) à l’occasion de la mise en place d’une prothèse totale de hanche (PTH) cimentée chez une patiente de 76 ans sans foramen ovale perméable. Durant la mise en place des composants acétabulaire et fémoral, ainsi qu’à la réduction de la hanche, est apparue une image de « tempête de neige » dans l’oreillette droite suivie d’emboles vermiformes de taille variable pouvant atteindre 1 à 5 cm de long. Durant la fermeture, du materiel embolique a été mis en évidence au niveau de la bifurcation de l’artère pulmonaire, adhérant à la paroi vasculaire. Aucune répercus-sion hémodynamique (rythme cardiaque, pressions artérielle et veineuse centrale) a n’a été observée. De même, aucune désaturation détectée par oxymérie de pouls et gazométrie artérielle n’a été constatée. La PetCO2 est restée stable. Ce cas clinique, en accord avec d’autres études, souligne que l’impact hémodynamique des emboles détectés par ETO au cours de PTH cimentées est faible.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • Noëlle D. Lafont
    • 1
  • Willy M. Kostucki
    • 1
    • 2
  • Philippe H. Marchand
    • 1
  • Michel N. Michaux
    • 1
    • 3
  • Jean G. Boogaerts
    • 1
  1. 1.Department of Anesthesiology and Intensive CareReine Fabiola HospitalMontignies-sur-SambreBelgium
  2. 2.Department of CardiologyAndré Vésale HospitalMontigny-le-TilleulBelgium
  3. 3.Department of OrthopedyReine Fabiola HospitalMontignies-sur-SambreBelgium

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