Fat Emboli Entrapped in the Tricuspid Valve Chordae Following Autologous Fat Grafting: An Echocardiographic-Pathological Correlation.

Fat embolism is a rare but feared complication of liposuction combined with autologous fat grafting (lipofilling). It carries a high mortality rate, predominantly affecting young patients with few or no comorbidities. To date, few guidelines exist, and management remains largely supportive. We report the case of a 40-year-old woman admitted to our center following cardiac arrest during breast lipofilling surgery. Given persistent hemodynamic instability and echocardiographic evidence of acute right ventricular overload with an intracardiac mass, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated immediately upon return of spontaneous circulation. The patient subsequently developed massive disseminated intravascular coagulation (DIC), requiring 52 units of blood products within 24 hours. The clinical course was further complicated by acute respiratory distress syndrome (ARDS), recurrent DIC with stroke, and cardiogenic shock due to acute right heart failure, ultimately leading to withdrawal of care. Autopsy revealed pulmonary fat emboli and adipose material entrapped within the tricuspid valve chordae, corresponding to the intracardiac mass identified on echocardiography. This case highlights the echocardiographic identification of a fat embolus entrapped within the tricuspid subvalvular apparatus following cosmetic fat grafting surgery. Its early recognition may reflect a substantial embolic burden and could provide additional prognostic information when interpreted alongside established clinical, hemodynamic, and echocardiographic parameters. The case also illustrates severe DIC as a potentially important systemic complication of fat embolism in this setting.