Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Malheiros, Suzana Mária Fleury; Massaro, Ayrton Roberto; Gabbai, Alberto Alain; Pessa, Clodualdo J. N.; Gerola, Luís Roberto; Branco, João Nelson Rodrigues; Filho, Edgar Bezerra Lira; Christofalo, Dejaldo M. J.; Federico, Darwin; Carvalho, Antônio Carlos; Buffolo, Ênio

doi:10.1590/s0004-282x2001000100002

Cited by 9 publications

(3 citation statements)

References 22 publications

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“…Most often, the tendency was not statistically significant and decreased as the time after surgery increased. [13][14][15][16] A similar study comparing CABG outcomes with valve surgery showed increasing rates of embolization for valve surgery, but no significant difference in neurocognitive test scores. 17 Comparisons of outcomes when the procedure is the same, but patient exposure to microemboli is different, have provided more compelling results.…”

Section: Introductionmentioning

confidence: 99%

Microemboli detection on extracorporeal bypass circuitsa

Lynch

2008

Perfusion

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Numerous authors have associated gaseous microembolization with adverse cerebral outcomes during cardiopulmonary bypass (CPB). The introduction to this review provides background on the connection between microemboli and adverse cerebral outcomes. This connection is often difficult to quantify, as outcomes depend on a number of factors, including the size of the bubble, where it passes through the patient, patient comorbidities and other factors. Nonetheless, numerous studies have shown statistically significant differences in the mean number of cerebral emboli detected in patients that stroked and those that did not, as well as for patients with major cardiac complications and patients with a longer length of hospital stay. Our introduction is followed by case reports and laboratory studies showing how monitoring for gaseous microemboli (GME) can be used to reduce the embolic load delivered to the patient through the bypass circuit. These methods include improved qualification of bypass circuit design prior to surgery, modification of priming procedures to reduce air in the circuit at the start of surgery, new methods for injecting drugs into the circuit during surgery, and better detection of removal of sources of air during surgery. The review concludes with background on the ultrasonic detection of GME, comparing through-transmission gross air detectors and Doppler ultrasound technology with fixed-beam ultrasonic imaging of emboli, a new ultrasonic technique that images moving emboli in the blood using a single ultrasound transducer element in a fixed position. This overview is meant to shed light on why different ultrasonic detection technologies report widely varying counts and emboli loads, and why fixed-beam ultrasonic imaging represents an improvement in the ability to monitor, measure and quantitate embolic load during CPB.

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Section: Introductionmentioning

confidence: 99%

Microemboli detection on extracorporeal bypass circuitsa

Lynch

2008

Perfusion

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“…Alguns trabalhos 1,[3][4][5][6][7] foram publicados na literatura médica ocidental descrevendo estes valores para os diferentes parâmetros de fluxo sanguí-neo. No Brasil, pesquisas [8][9][10][11] foram realizadas com relação à aplicação do DTC em diferentes situações clínicas, porém para valores de normalidade são desconhecidos. Fatores como hematócrito, idade, sexo e pressão arterial parcial de CO2 (PaCO2) podem influenciar nos valores das medidas realizadas em diferentes populações.…”

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Doppler transcraniano convencional em voluntários assintomáticos: variabilidade e valores de referência para parâmetros de fluxo sanguíneo

Barbosa

Abdala

Carrete

et al. 2006

Arq. Neuro-Psiquiatr.

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RESUMO - Reference values for measures of blood flow velocities and impedance indexes in healthy individuals through conventional transcranial DopplerABSTRACT -Objective: To establish reference values for measures of blood flow velocities and impedance indexes in healthy individuals through conventional transcranial Doppler (TCD) and to observe their variations in relation to the age and sex. Method: 88 asymptomatic volunteers were examined without antecedents of cardiac, peripheral or cerebrovascular diseases. The TCD were accomplished by the same examiner. The middle, anterior and posterior cerebral arteries were studied through the temporal acoustic window and the vertebral and basilar arteries through the suboccipital acoustic window. The values of mean velocity (MV), peak-systolic velocity (PSV), final diastolic velocity (FDV), resistance index (RI) and pulsatility index (PI) of each examined arterial segment were filed. Results: The reference limits found by us were similar to the described by other authors for all of the studied parameters. There was tendency of the flow velocities decrease and of the impedance indexes increase with moving forward of the age. The values of velocities in the women were superior to the found in men. Conclusion: TCD was shown useful in the evaluation of hemodynamic cerebral for our population. Our results are similar to the other studies, so much in the reference values as in relationship with the age and the sex.

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“…Research lines have been established with monitoring of surgical and endovascular procedures to correlate the presence of MES and post-surgery neurologic changes [25][26][27][28][29] . Such procedure may in the future identify crucial sites for surgical manipulation in carotid stenoses.…”

Section: Monitoring Of Microembolismmentioning

confidence: 99%

Uso do doppler transcraniano na fase aguda do acidente vascular cerebral isquêmico

Zétola

Lange

2006

Arq. Bras. Cardiol.

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The first clinical trials on the utility of Transcranial Doppler (TCD) in acute ischemic stroke (AIS) were conducted still in the pre-thrombolysis stage. Middle cerebral artery (MCA) mean flow velocity (MV) below 20 cm/sec or 50% below contralateral MCA within 24 hours translates worse prognostics factors 1 . Intravenous thrombolysis in the management of AIS brought forth an even higher utility of TCD in the acute phase -to add to emergency evaluation -thus allowing the identification of intracranial occlusion and acting as a unique tool for continuous monitoring of vessel recanalization 2 . More recent study designs suggest that changes found in TCD should be added to inclusion criteria for the use of intravenous thrombolytic, since that therapeutic regimen is potentially indicated and beneficial in cases of encephalic ischemia with intracranial artery branch occlusion 3-5 .

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Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Cited by 9 publications

References 22 publications

Microemboli detection on extracorporeal bypass circuitsa

Microemboli detection on extracorporeal bypass circuitsa

Doppler transcraniano convencional em voluntários assintomáticos: variabilidade e valores de referência para parâmetros de fluxo sanguíneo

Uso do doppler transcraniano na fase aguda do acidente vascular cerebral isquêmico

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