Thromboembolism coincident with tourniquet deflation during total knee ³

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arthroplasty [see comments]. Parmet JL. Berman AT. Horrow JC. Harding S. Rosenberg H. Comment in: Lancet 1993 Jun 19;341(8860):1606 Despite prophylactic therapy, pulmonary embolism remains the leading cause Á of perioperative mortality in patients undergoing total knee arthroplasty (TKA). We used transoesophageal echocardiography to monitor 29 consecutive patients during TKA. Showers of substantial amounts of echogenic material, lasting for 3-15 min, were visible in the right atrium and ventricle within 10-15 s of tourniquet deflation in all patients. A 3 x 6 mm fresh thrombus was aspirated from the central circulation of one patient. Another patient, who had had a Greenfield filter placed for previous thromboembolism, showed very little echogenic material after tourniquet deflation. The composition and importance of these echogenic emboli remain uncertain. *