CARDIAC SURGERY Evaluation of brain lesions in patients after coronary artery bypass grafting using MRI with the emphasis on susceptibility-weighted imaging

Abstract

IntroductionPatients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders.The aim of the studyThe aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG.Material and methodsPatients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed.ResultsFifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.ConclusionsThe use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.

Cognitive function after heart transplantation: Comparing everolimus‐based and calcineurin inhibitor‐based regimens

“…This finding supports neuropathological reports from the early era and is consistent with the notion that HTx recipients have a high lifetime cumulative risk of cerebrovascular pathology. The extent of individual cerebrovascular pathology reflects the sum of minor and major cerebrovascular events that occurred before, during, and after successful HTx, including cardiac arrest, cerebral bleeding/infarction, as well as undesirable consequences of medical procedures (eg, left heart catheterization, former cardiac surgery), underlying disease, and comorbidities (eg, coronary heart disease, diabetes mellitus, hypertension).…”

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

“…Follow-up MRI examinations were available for 56 patients with a median time after first postinterventional scan of 6 months (interquartile range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In 91.1% (51/56) of those, there was no further increase in SWI lesions (Figure 2).…”

“…Another study showed that SWI lesions occur after coronary bypass surgery, but only when CPB was used and with a similar frequency. 13 It is known that the CPB circuit may contain air emboli and/or microparticles, which may also be detected using transcranial Doppler ultrasound. 26 However, it is rather unlikely that the postoperative SWI lesions are mainly caused by air since they were also detectable 6 weeks after surgery.…”

“…12 Furthermore, cardiopulmonary bypass (CPB) during valve implantation was also shown to be associated with postinterventional SWI lesions. 5,[13][14][15] No data are available on patients receiving biological heart valves (bHV). Therefore, it is unclear whether patients with transcatheter aortic valve implantation who do not require CPB or patients with bHV may also show those SWI lesions.…”

Morphological and Perfusion Predictors of Distant Cerebral Disorders in Cardiac Surgery Patients

“…Как правило, у пациентов соответствующей возрастной категории нередко выявляются атрофические изменения вещества мозга, чему соответствует расширение полостной системы мозга и проявления церебральной микроангиопатии в виде феномена лейкоареоза. Лейкоареоз -это нейровизуализационный симптом в виде обычно симметричных двусторонних диффузных изменений белого вещества головного мозга с понижением плотности на КТ-изображениях или изменением сигнала на МР-изображениях [1][2][3][4]. По локализации лейкоареоз делится на перивентрикулярный и субкортикальный: перивентрикулярный лейкоареоз представлен в виде изменений по периметру боковых желудочков, субкортикальный лейкоареоз имеет вид рассеянных очагов или очагов сливного характера.…”