Document Detail


Detection of aortic emboli by transesophageal echocardiography during coronary artery bypass surgery.
MedLine Citation:
PMID:  8725409     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to determine whether emboli can be detected within the aortic lumen in patients undergoing coronary artery bypass surgery (CABG) and to relate the appearance of emboli to specific operative events. DESIGN: Twenty patients were prospectively studied intra-operatively. SETTING: Subjects were inpatients in an academic medical center. PARTICIPANTS: All participants were scheduled for elective, isolated CABG. INTERVENTIONS: Patients were continuously monitored using transesophageal echocardiography (TEE) from aortic cannulation to bypass discontinuation. After completion of the aortic examination, the probe was focused at the level of the aortic arch, just before the takeoff of the left subclavian artery. Emboli were defined as echogenic intraluminal signals not present in the same position on consecutive cross-sectional frames. RESULTS: Intraluminal emboli were detected in all subjects, with a mean number of 535 and range of 8 to 1,885. Embolization was unevenly distributed through the procedure. A mean of 224 (42%) of 535 were detected within 4 minutes of aortic cross-clamp release and another 140 (24%) appeared after partial occlusion clamp release. Together, clamp placement and release represented 84% of all emboli. Emboli detected after clamp release were large, echodense particles easily distinguishable from the small, indistinct, poorly echogenic signals observed at bypass initiation. CONCLUSIONS: Emboli can be visualized within the aortic lumen during CABG. Confirming previous reports, the majority of emboli detected are related to manipulation of aortic clamps. The composition and clinical significance of embolic material are unclear. The value of intraoperative TEE monitoring in predicting neurologic outcome remains to be determined.
Authors:
F S Yao; D Barbut; D N Hager; R R Trifiletti; J P Gold
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  10     ISSN:  1053-0770     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-09-24     Completed Date:  1996-09-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  314-7     Citation Subset:  IM    
Affiliation:
Department of Neurology, Cornell University Medical College, New York, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aorta, Thoracic / ultrasonography
Aortic Diseases / ultrasonography*
Cardiopulmonary Bypass
Coronary Artery Bypass*
Echocardiography, Transesophageal*
Embolism / ultrasonography*
Female
Forecasting
Heart Arrest, Induced
Humans
Hypothermia, Induced
Intraoperative Care*
Male
Middle Aged
Monitoring, Intraoperative
Neurologic Examination
Prospective Studies
Surgical Procedures, Elective

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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