Document Detail


Mild to moderate atheromatous disease of the thoracic aorta and new ischemic brain lesions after conventional coronary artery bypass graft surgery.
MedLine Citation:
PMID:  15284448     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: The presence of new ischemic brain infarcts, detected by diffusion-weighted magnetic resonance imaging (DW-MRI), have been reported in considerable number of patients after cardiac surgery. We sought to determine the role of proximal thoracic aortic atheroma in predicting embolic events and new ischemic brain lesions in patients undergoing conventional coronary revascularization surgery. METHODS: Transesophageal echocardiography and epiaortic scanning was performed to assess the severity of aortic atherosclerosis in the ascending aorta and the aortic arch. Patients were allocated to either low-risk group, (intimal thickness < or =2mm), or high-risk group (intimal thickness >2mm). Transcranial Doppler was used to monitor the middle cerebral artery. DW-MRI was performed 3-7 days after surgery. The NEECHAM Confusion Scale was used for assessment and monitoring patient consciousness level. RESULTS: Patients in the high-risk group were considerably older; 71+/-6 (n=38) versus 67+/-6 (n=72) years, P=0.004 and were more likely to have impaired left ventricular function. Confusion was present in 6 (16%) patients in the high-risk group and 5 (7%) patients in the low-risk group. Patients in the high-risk group had a three-fold increase in median embolic count, 223.5 versus 70.0, P=0.0003. DW-MRI detected brain lesions were only present in patients from high-risk group, 61.5 versus 0%, P<0.0001. There was significant correlation between the NEECHAM scores and embolic count in the high-risk group; r=0.63, P<0.001. CONCLUSIONS: The findings of this investigation suggest that mild to moderate atheromatous disease of the ascending aorta and the aortic arch (intimal thickness >2mm) is a major contributor to ischemic brain injury after cardiac surgery.
Authors:
George Djaiani; Ludwik Fedorko; Michael Borger; David Mikulis; Jo Carroll; Davy Cheng; Keyvan Karkouti; Scott Beattie; Jacek Karski
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Publication Detail:
Type:  Journal Article     Date:  2004-07-29
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  35     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-27     Completed Date:  2005-04-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e356-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Toronto General Hospital, University Health Network, University of Toronto, Canada. george.djaiani@uhn.on.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aorta, Thoracic / pathology*,  ultrasonography
Aortic Diseases / complications*,  pathology,  ultrasonography
Arteriosclerosis / complications*,  pathology,  ultrasonography
Brain Ischemia / epidemiology,  etiology*,  prevention & control,  ultrasonography
Comorbidity
Confusion / etiology
Coronary Artery Bypass*
Diffusion Magnetic Resonance Imaging
Echocardiography, Transesophageal
Female
Humans
Intracranial Embolism / epidemiology,  etiology*,  prevention & control,  ultrasonography
Male
Middle Aged
Postoperative Complications / epidemiology,  etiology*,  prevention & control,  ultrasonography
Preoperative Care
Risk
Ultrasonography, Doppler, Transcranial
Ventricular Dysfunction, Left / epidemiology

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