Cardiovascular changes after pulmonary cement embolism: an experimental study in sheep.
OBJECTIVE
Most cement leaks during vertebroplasty are asymptomatic, but pulmonary cement embolism has been reported to cause cardiovascular disturbances and even death. Adding hydroxyapatite (HA) to polymethylmethacrylate (PMMA) cement to reduce the quantity of barium may aggravate cardiovascular deterioration in the event of cement embolism by activating coagulation. Thus, we investigated the cardiovascular changes after pulmonary cement embolism of PMMA with and without HA.


METHODS
In 13 sheep, cement (2.0 mL) was injected into the pulmonary trunk. Two different cements were used: 1) standard PMMA and 2) PMMA with 10% HA (PMMA & HA). Arterial, central venous and pulmonary arterial pressures, heart rate, and cardiac output were monitored continuously until 60 minutes after the injection. Blood gases and coagulation parameters (antithrombin, D-dimer) were measured before and after injection.


RESULTS
Mean pulmonary arterial pressure had increased by approximately 9% (PMMA) and 14% (PMMA & HA) 1 minute after injection and stayed elevated. There were no significant differences between the groups. No evidence of thromboembolism was detected.


CONCLUSIONS
Cement embolism did not result in clinically significant pulmonary arterial hypertension. Adding HA to PMMA cement did not cause more severe cardiovascular changes.
Krebs
J
J
MEM Research Center, Institute for Surgical Technology and Biomechanics, Medical Faculty, University of Bern, Switzerland. jorg.krebs@memcenter.unibe.ch
Aebli
N
N
Goss
B G
BG
Wilson
K
K
Williams
R
R
Ferguson
S J
SJ
D000818:Animals; D001794:Blood Pressure; D004338:Drug Combinations; D017886:Durapatite / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006339:Heart Rate; D008768:Methylmethacrylates / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000209:etiology* / Q000503:physiopathology*; D012756:Sheep
D004338:Drug Combinations; D008768:Methylmethacrylates; C506662:vertebroplastic; D017886:Durapatite