Keith B. Allen, MD
Central Message.
Arkansas toothpick—a tale of cement gone astray.
See Article page 358.
In this edition of JTCVS Techniques, Weininger and colleagues1 report a fascinating case of intracardiac polymethylmethacrylate cement embolism in a patient 1 week following an L5 kyphoplasty. Bone cement embolization to the heart through the venous system, while uncommon, likely occurs more frequently then reported. The novelty of this case is emphasized by the incredible video showing removal of what some familiar with Bowie knives would call an “Arkansas toothpick.” The etiology of the embolus likely occurred by accidental direct injection of the cement into a lumbar vein. While the cardiac team at Yale expertly managed this complication, dissemination of this complication to orthopedic surgeons would be important to highlight the potential dangers of polymethylmethacrylate cement that is commonly used in their procedures. This article should also remind cardiac surgeons that our field is not immune to substances such as bone wax embolizing, and the emergence of hemostatic sealants may have the same propensity.2
Footnotes
Disclosures: The author reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
References
- 1.Weininger G., Sekar R.B., Elefteriades J.A. Intracardiac polymethylmethacrylate cement embolism. J Thorac Cardiovasc Surg Tech. 2021;10:358–360. doi: 10.1016/j.xjtc.2021.09.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Robicsek F., Masters T.N., Littman L., Born G.V.R. The embolization of bone wax from sternotomy incisions. Ann Thorac Surg. 1981;31:357–359. doi: 10.1016/s0003-4975(10)60967-8. [DOI] [PubMed] [Google Scholar]