Methacrylate is polymer used as a bone cement in orthopedic procedures that can rarely embolize, resulting atrial perforation and pulmonary artery occlusion. Retrieval of emboli typically requires cardiopulmonary bypass deep hypothermic circulatory arrest. In this report, we describe the off-pump removal massive left methacrylate embolus using surface ultrasound localization, partial cross-clam...