EMBOLISM DETECTED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING HIP-ARTHROPLASTY

This case report demonstrates embolization of echogenic material detec ted by transoesophageal echocardiography during a cemented total hip a rthroplasty in a 76-yr-old woman without patent foramen ovale. During the placement of the acetabular and femoral components, and during rel ocation of the hip joint, a ''snow flurry'' appearing in the right atr ium was followed by several highly echogenic and mobile emboli of vari ous 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 pulmo nary artery adherent to the vascular wall of the bifurcation of the ma in pulmonary artery. No changes were observed in any haemodynamic vari able monitored (heart rare, systemic and right atrial pressures). Also , no desaturation was detected by pulse oximetry and blood gases at th e rime of embolism and there was no decrease in PETCO(2). This case re port is in line with other studies which failed to show a haemodynamic impact of TEE detected emboli during THA.