TY - JOUR
T1 - Value of intraoperative left ventricular microbubbles detected by transesophageal two-dimensional echocardiography in predicting neurologic outcome after cardiac operations
AU - Topol, Eric J.
AU - Humphrey, Linda S.
AU - Borkon, A. Michael
AU - Baumgartner, William A.
AU - Dorsey, Debra L.
AU - Reitz, Bruce A.
AU - Weiss, James L.
N1 - Funding Information:
From the Cardiology Division, Department of Medicine; Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine; and Division of Cardiothoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland. This study was supported by lschemic Heart Disease SCDR Grant 2~50~ HL-17655 from the National Heart, Lung and Blood Institute, Bethesda, Maryland. Dr. Top01 was supported by a research fellowship from the American Heart Association, Maryland Affiliate, Baltimore, Maryland. Manuscript received February 11, 1985; revised manuscript received April 23, 1985, accepted April 27, 1985. Address for reprints: James L. Weiss, MD, Cardiology Division, Carnegie 59 1, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21205.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 1985/11/1
Y1 - 1985/11/1
N2 - To determine whether the presence or absence of left ventricular (LV) intracavitary microbubbles during cardiac surgery predicts neurologic sequelae, 82 patients undergoing cardiac surgery were studied using transesophageal 2-dimensional (2-D) echo-cardiography. Cross-sectional images were recorded just before and immediately after cardio-pulmonary bypass and stop frames were reviewed for the presence of microbubbles, rated as: 0 = absent, 1 = fewer than 5/frame, 2 = 10 to 25/frame, 3 = too numerous to count. Microbubbles were detected after cardiopulmonary bypass in 34 patients (41%) and found more often in valvular or other intracardiac manipulations than in coronary revascularization, 30 of 40 vs 4 of 42, respectively (p <0.001). When grade 2 or 3 microbubbles were identified (22 of 34 patients), mechanical attempts to eradicate them were not successful. Postoperative follow-up in all patients revealed no new focal neurologic deficits. Prolonged encephalopathy (confusional state more than 72 hours) occurred in 4 of 48 patients with no detectable microbubbles and in 3 of 34 patients with microbubbles (difference not significant). Thus, intracavitary left ventricular microbubbles are often detected during cardiac operations, particularly during valve replacement, but are not predictive of postoperative neurologic complications. This is true even if microbubbles are densely concentrated; attempts to eradicate microbubbles are unsuccessful and may be unnecessary.
AB - To determine whether the presence or absence of left ventricular (LV) intracavitary microbubbles during cardiac surgery predicts neurologic sequelae, 82 patients undergoing cardiac surgery were studied using transesophageal 2-dimensional (2-D) echo-cardiography. Cross-sectional images were recorded just before and immediately after cardio-pulmonary bypass and stop frames were reviewed for the presence of microbubbles, rated as: 0 = absent, 1 = fewer than 5/frame, 2 = 10 to 25/frame, 3 = too numerous to count. Microbubbles were detected after cardiopulmonary bypass in 34 patients (41%) and found more often in valvular or other intracardiac manipulations than in coronary revascularization, 30 of 40 vs 4 of 42, respectively (p <0.001). When grade 2 or 3 microbubbles were identified (22 of 34 patients), mechanical attempts to eradicate them were not successful. Postoperative follow-up in all patients revealed no new focal neurologic deficits. Prolonged encephalopathy (confusional state more than 72 hours) occurred in 4 of 48 patients with no detectable microbubbles and in 3 of 34 patients with microbubbles (difference not significant). Thus, intracavitary left ventricular microbubbles are often detected during cardiac operations, particularly during valve replacement, but are not predictive of postoperative neurologic complications. This is true even if microbubbles are densely concentrated; attempts to eradicate microbubbles are unsuccessful and may be unnecessary.
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U2 - 10.1016/0002-9149(85)91134-8
DO - 10.1016/0002-9149(85)91134-8
M3 - Article
C2 - 4061300
AN - SCOPUS:0022401427
VL - 56
SP - 773
EP - 775
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 12
ER -