Cardiac and pulmonary fat embolectomy for suspected fat embolus.

Nelson, C. S. (1974). Thorax, 29, 134-137. Cardiac and pulmonary fat embolectomy for suspected fat embolus. There is no specific treatment of fat embolism, whether the embolism is predominantly cerebral, pulmonary, renal or mesenteric. A 46-year-old man had fractured his right femur for the third time in December 1971. Seventy hours later he suddenly developed the cardiovascular, respiratory, and cerebral manifestations ofpost-traumatic fat embolism. His chest radiograph at the onset ofsymptoms was consistent with fat embolism. He underwent cardiac and pulmonary embolectomy on 7 December 1971 and made a most dramatic recovery. His haemobronchorrhoea, dyspnoea, tachypnoea, hyperpyrexia, and profound shock disappeared at the end of the operation. His only postoperative cerebral disturbance was mild disorientation. The pathophysiological changes accompanying fat embolism are due to toxic vasculitis and fat macroglobule aggregations blockading the pulmonary arterioles and capillaries. The blockading concept is the basis for cardiac and pulmonary fat embolectomy. Only a larger series embodying a multicentre trial will show whether or not cardiopulmonary fat embolectomy is a specific treatment of massive fat embolism. The purpose of this paper is to report on the technique and result of embolectomy for a suspected fat embolus following fracture of the femur.