Ultra-Delayed Intracardiac Cement Embolism After Percutaneous Vertebroplasty: A Case Report and Review of Management...

Cardiac cement embolism is a rare but potentially life-threatening complication of percutaneous vertebroplasty, usually occurring during or shortly after the procedure. Delayed presentations remain poorly recognized. Here, we report a rare case of intracardiac bone cement embolism 2.5 years after vertebroplasty. A 76-year-old man with a history of lumbar vertebroplasty presented with progressive exercise intolerance and intermittent chest pain. Transthoracic echocardiography and cardiac computed tomography angiography revealed three rod-shaped, high-density foreign bodies in the right ventricle, one of which was embedded in the ventricular myocardium. Coronary angiography demonstrated severe stenosis of the left anterior descending artery. Given the risks of cardiac perforation and coexisting coronary artery disease, simultaneous surgical removal of the cement emboli and coronary artery bypass grafting were performed under cardiopulmonary bypass. All foreign bodies were successfully removed, and the right ventricular wall was reinforced. The patient recovered uneventfully, with resolution of symptoms and preserved cardiac function during 6 months of follow-up. This report highlights the possibility of ultra-delayed and asymptomatic intracardiac cement embolism after vertebroplasty. Long-term cardiovascular surveillance may be warranted in patients with a history of vertebroplasty presenting with unexplained cardiopulmonary symptoms. Although earlier post-vertebroplasty imaging was unavailable, the embolic route likely traversed the pulmonary circulation before lodging in the right ventricle. Given the asymptomatic latency, selective chest imaging may aid early detection in patients with high-risk leakage patterns, though routine screening remains impractical.