Patent foramen ovale, bone cement implantation syndrome and paradoxical embolism : Case study and pathophysiological aspects.
Ludwig Brandt, Ulrike Artmeier-Brandt, Klara Luisa Brandt
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Case in brief
An 81-year-old woman with a known patent foramen ovale developed bone cement implantation syndrome during cemented hip arthroplasty, followed by a paradoxical embolic stroke involving a large cerebral vessel. The report discusses how bone cement implantation syndrome may contribute to paradoxical embolism by releasing gaseous or particulate emboli into the venous circulation and increasing pulmonary vascular resistance, potentially reversing the interatrial shunt. The authors note that estimates of paradoxical embolism risk during joint replacement vary widely and emphasize prompt diagnostic evaluation when postoperative neurological or hemodynamic abnormalities occur.
What made this case unusual
The case documents the perioperative concurrence of a known patent foramen ovale and bone cement implantation syndrome followed by a large-vessel paradoxical embolic stroke.
Diagnostic / clinical pearl
In a patient with a patent foramen ovale who develops bone cement implantation syndrome, new neurological or hemodynamic abnormalities warrant immediate comprehensive evaluation for paradoxical embolism.