Detection of right heart emboli by transesophageal echocardiography in cement implantation syndrome in an elderly patient

Femoral fractures are common and lethal among elderly patients. The elderly suffer more perioperative risks because of their complicated medical conditions and poor physical reserves. During cemented arthroplasty surgery in the elderly, unstable hemodynamic changes are frequently noted when the cement and prosthesis are inserted. Transesophageal echocardiography (TEE) allows rapid perioperative diagnosis and management of hemodynamic changes. We report an elderly patient with paroxysmal atrial fibrillation, in whom a huge serpentine embolus was noted by TEE. Although cardiovascular collapse was encountered during cemented hip arthroplasty surgery, the patient was successfully resuscitated and the related perioperative risk was managed by TEE application.