PMC10390769_01
(A) The three-dimensional CT reconstruction demonstrated a tree-branch-shaped high-density foreign material in the RV (long arrow), extending through the MPA and RPA into the ascending branch and middle-lobe branch of the RPA (long arrow), indicating the diagnosis of PMMA cement embolism. The cement seemed to enter the vein system through the azygos vein (short arrow). (B) The transesophageal echocardiography demonstrated a rod-shaped hyperechoic foreign body in the RV and RPA (arrow).
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F1
A three-dimensional reconstruction based on a computed tomography for pulmonary artery demonstrated a tree-branch-shaped foreign body in the RV, extending through the MPA and RPA into the right upper and middle-lobe pulmonary artery (Figure 1A). The transesophageal echocardiography found a rod-shaped hyperechoic foreign body in the RV and RPA (Figure 1B) and 2 + pulmonary regurgitation.
(A) Through an RA incision, a circumferential piece of the PMMA cement (long arrow) can be seen tangling with tricuspid chorda (short arrow). (B) Through an MPA incision, the PMMA cement was found to be fractured with a sharp end. (C) The PMMA cement (arrow) can be seen through an RPA incision. (D) The gross appearance of the surgically resected specimen, indicating that the PMMA cement embolus was completely removed.
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F2
The RV was explored through a right atrial incision, and a circumferential cement was found entangled with a tricuspid chorda (Figure 2A). Through an MPA incision, the cement was found to be fractured with a spear-shaped end (Figure 2B). The cement in the ascending and middle-lobe branch was removed from the intima by meticulous blunt dissection (Figure 2C), under transient circulatory arrest (5 min for each branch). The PMMA embolism was completely removed (Figure 2D).