Transcardiac echocardiography during invasive intramedullary procedures.
J Bone Joint Surg Br
; 77(3): 450-5, 1995 May.
Article
em En
| MEDLINE
| ID: mdl-7744935
ABSTRACT
We performed transoesophageal echocardiography in 111 operations (110 patients) which included medullary reaming for fresh fractures of the femur and tibia, pathological lesions of the femur, and hemiarthroplasty of the hip. Embolic events of varying intensity were seen in 97 procedures and measured pulmonary responses correlated with the severity of embolic phenomena. Twenty-four out of the 25 severe embolic responses occurred while reaming pathological lesions or during cemented hemiarthroplasty of the hip and, overall, pathological lesions produced the most severe responses. Paradoxical embolisation occurred in four patients, all with pathological lesions of the femur (21%); two died. In 12 patients large coagulative masses became trapped in the heart. Extensive pulmonary thromboembolism with reamed bone and immature clot was found at post-mortem in two patients; there was severe systemic embolisation of fat and marrow in one who had a patent foramen ovale and widespread mild systemic fat embolisation in the other without associated foraminal defect. Sequential analysis of blood from the right atrium in five patients showed considerable activation of clotting cascades during reaming.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fraturas da Tíbia
/
Embolia
/
Fraturas do Fêmur
/
Fixação Intramedular de Fraturas
/
Prótese de Quadril
Tipo de estudo:
Etiology_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
Idioma:
En
Revista:
J Bone Joint Surg Br
Ano de publicação:
1995
Tipo de documento:
Article
País de afiliação:
Reino Unido