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Renal Fat Emboli, Maltese Crosses, and Heart Surgery

Stanley M. Lee, MD
JAMA. 1986;256(1):40. doi:10.1001/jama.1986.03380010044020.
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To the Editor.—  We observed numerous large fat particles in the urine of a patient several hours after placement of an artificial heart. The significance of this phenomenon and its relationship to post-cardiopulmonary bypass renal insufficiency remains undetermined. We therefore prospectively studied ten patients undergoing heart surgery requiring cardiopulmonary bypass. The patients ranged in age from 18 months to 75 years. The most common operations were coronary bypass or valve replacement. Preoperative urinalysis was performed to exclude the presence of proteinuria or oval fat bodies. None of the patients had hyperlipidemia. The urine specimens were examined by phase and polarized microscopy. Postoperative urine specimens were obtained at periods ranging from one to seven hours following completion of cardiopulmonary bypass.In seven of ten patients, large fat bodies were observed. These particles were highly refractile and in polarized light had a typical "maltese cross" appearance and ranged in size from approximately


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