Transcardiac echocardiography during invasive intramedullary procedures

Area of Science:

• Orthopedic Surgery
• Cardiovascular Imaging
• Hematology

Background:

• Medullary reaming and hip arthroplasty are common orthopedic procedures.
• Embolic events can complicate these surgeries, leading to significant morbidity and mortality.
• Transesophageal echocardiography (TEE) allows real-time monitoring of cardiac and pulmonary events during surgery.

Purpose of the Study:

• To investigate the incidence and severity of embolic events during medullary reaming and hip arthroplasty using TEE.
• To correlate pulmonary responses with the severity of embolic phenomena.
• To identify specific surgical factors associated with severe embolic events.

Main Methods:

• Transesophageal echocardiography was performed during 111 orthopedic operations (110 patients).
• Procedures included medullary reaming for femur/tibia fractures, femur pathological lesions, and hip hemiarthroplasty.
• Pulmonary responses were measured and correlated with observed embolic phenomena.

Main Results:

• Embolic events occurred in 97% of procedures, with varying intensity.
• Severe embolic responses (24/25) were predominantly associated with reaming pathological bone lesions or cemented hip arthroplasty.
• Pathological lesions yielded the most severe responses; paradoxical embolization occurred in 4 patients with femur lesions, leading to 2 deaths.

Conclusions:

• Medullary reaming and cemented hip arthroplasty pose a significant risk of embolic events.
• Pathological bone lesions are associated with the most severe embolic and paradoxical embolic phenomena.
• TEE is valuable for detecting and assessing embolic events during these orthopedic procedures.