Abstract
Background: In patients with pre-existing pulmonary hypertension undergoing surgery, there is an inherent risk of decompensation and right ventricular failure. Cemented hemi-arthroplasty in patients with pre-existing pulmonary hypertension predisposes them even more to morbidity and mortality from bone cement implantation syndrome (BCIS) with worsening of pulmonary hypertension. This risk should be recognized and steps taken for increased awareness, risk counselling and minimization of adverse effects. Case: We report a case of successful resuscitation of a patient with pre-existing pulmonary hypertension who developed 2 episodes of cardiac arrests—Grade 3 BCIS, shortly after cement implantation. Learning Points: Patients with pre-existing pulmonary hypertension for cemented hemi-arthroplasty are at additional risks and should be identified. Adequate risk counselling needs to be undertaken prior to surgery. A multi-disciplinary team effort is required. Discussion should be undertaken with the orthopaedic surgeon about the risks and benefits of using cemented implants. The anaesthetist needs to be vigilant for signs of BCIS, especially at the time of cement implantation and institute immediate resuscitation. Supportive treatment is the mainstay of management.
Highlights
In patients with pre-existing pulmonary hypertension undergoing surgery, there is an inherent risk of decompensation and right ventricular failure
Cemented hemi-arthroplasty in patients with pre-existing pulmonary hypertension predisposes them even more to morbidity and mortality from bone cement implantation syndrome (BCIS) with worsening of pulmonary hypertension. This risk should be recognized and steps taken for increased awareness, risk counselling and minimization of adverse effects
Case: We report a case of successful resuscitation of a patient with pre-existing pulmonary hypertension who developed 2 episodes of cardiac arrests—Grade 3 BCIS, shortly after cement implantation
Summary
One hypothesis is the embolic model, in which emboli from increased intramedullary pressure lead to increase in pulmonary vascular resistance and right heart failure [1] [2]. There are many reports on BCIS, not many focused on patients with pre-existing pulmonary hypertension. There is a study by Memtsoudis et al [3] which showed that there is increased risk of perioperative mortality for patients with pulmonary hypertension undergoing major joint replacement. We report a case of successful resuscitation of a patient with pre-existing pulmonary hypertension who developed 2 episodes of cardiac arrests—Grade 3 BCIS, shortly after cement implantation. It highlights the need to be aware of the patient’s risk profile, vigilant monitoring and timely resuscitation
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