[abstract] WHEN DOES CEREBRAL EMBOLISM OCCUR DURING LEFT HEART VALVE SURGERY.

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[abstract] WHEN DOES CEREBRAL EMBOLISM OCCUR DURING LEFT HEART VALVE SURGERY.

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Title: [abstract] WHEN DOES CEREBRAL EMBOLISM OCCUR DURING LEFT HEART VALVE SURGERY.
Author: Mitchell, SJ; Gorman, DF
Abstract: BACKGROUND: Cerebral arterial embolism by solid particles and bubbles occurs during cardiac surgery and this sometimes necessitates post-operative hyperbaric oxygen treatment. The incidence of peri-operative stroke and post-operative neuropsychological deficits correlates well with emboli exposure. Open chamber procedures such as valve surgery have a higher risk of embolism. We measured the level of embolism throughout heart valve surgery to identify remediable causes. METHODS: 57 adult patients undergoing left heart valve surgery were continuously monitored over the right common carotid artery using a Doppler emboli counter. The operation was subdivided into emboli counting periods as follows: A. 5 minutes prior to entering the pericardium; B. the end of A to the beginning of cardiopulmonary bypass (CPB); C. the first 10 minutes of CPB; D. the end of C to beginning of rewarming; E. beginning of rewarming to 34°C; F. 34°C to aortic declamping; G. aortic declamping until withdrawal of CPB; and H. 20 minutes following withdrawal of CPB. RESULTS: The total operative emboli count was between 342 and 6852 (median 1647). Most emboli signals were acoustically typical of bubbles. The mean percentage of the total operative emboli count recorded in each phase is shown in the figure. (Figure on page 66 of supplement.) CONCLUSIONS: Left heart valve surgery patients are exposed to many cerebral arterial emboli. Almost all of these are bubbles appearing after aortic declamping and resumption of cardiac ejection (phases G and H). Conventional techniques for "deairing" the left heart at the end of surgery need to be improved.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org)
URI: http://archive.rubicon-foundation.org/6951
Date: 2000

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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