Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain

Muraoka, Ryusuke; Yokota, Michio; Aoshima, M; Kyoku, I; Nomoto, S; Kobayashi, Akira; Nakano, Hiroyuki; Ueda, Ken; Saito, Akihiro; Hojo, Hiroatsu

doi:10.1016/s0022-5223(19)37599-3

Cited by 87 publications

(13 citation statements)

References 11 publications

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“…The aetiology of cognitive dysfunction after cardiac surgery has not been elucidated, so it remains to be answered whether hypoperfusion, embolism or other mechanisms are involved. Imaging techniques, such as CT scan or MR scan, have not provided clear evidence that infarction or diffuse neuron loss occur in a substantial proportion of the patients (20)(21)(22). Neuron cell membrane dysfunction or death may lead to leakage of intracellular proteins that can be detected in cerebrospinal fluid or in the blood through the measurement of biochemical markers of neural tissue such as NSE.…”

Section: Discussionmentioning

confidence: 99%

Do blood levels of neuron‐specific enolase and S‐100 protein reflect cognitive dysfunction after coronary artery bypass?

Rasmussen

Christiansen

Hansen

et al. 1999

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

Do blood levels of neuron‐specific enolase and S‐100 protein reflect cognitive dysfunction after coronary artery bypass?

Rasmussen

Christiansen

Hansen

et al. 1999

Acta Anaesthesiol Scand

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“…Obvious but not fatal brain damages are still causing developmental morbidity. Mild or occult changes have been revealed by computed tomographic scanning, 6 and by assessing postoperative intellectual development. 7 ' 8 Symptoms do not always accompany the abnormalities noted by scans, and intellectual assessment does not afford accurate comparison since the patients, usually too young, can be tested reliably after long intervals.…”

Section: Discussionmentioning

confidence: 99%

Cerebral cellular response to profound hypothermia

Watanabe

1993

Cardiol Young

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In our first two experiments, we examined brain tissue pH and tensions of oxygen and carbon dioxide in dogs core cooled to 20°C. So as to evaluate the effects of 60 minutes of circulatory arrest, 120 minutes of low-flow perfusion (25 mI/kg/mm), and 120 minutes of moderate-flow perfusion (50 mi/kg/mm), all conducted with and without pulsatile assistance. We further determined the effects of blood gas strategy on the same variables with 60 minutes of circulatory arrest. In a third experiment, we directly observed microcirculation at the surface of the brain during profoundly hypothermic perfusion. In the fourth experiment, we measured cerebral blood flow, oxygen consumption, and excessive production of lactate. Profound anoxia occurred within 20 minutes of circulatory arrest, causing severe and progressive acidosis in the brain tissues along with hypercapnia. The inhalation of 5% or 7% carbon dioxide during core cooling made the brain unacceptably acidotic. The brain acidosis was mild with low flow perfusion, and slight with moderate-flow perfusion. Pulsatile assistance improved acidosis in the brain tissues at all rates of flow. It also improved the microcirculation, the patent number of arterioles and stabilized flow in bridging veins. Cerebral metabolism became aerobic without alterations in cerebral consumption of oxygen during low-flow perfusion. We recommend flow rates above 25% of normal, alpha-stat strategy, and pulsatile assistance for better protection of the brain during profound hypothermia.

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“…3637 Microemboli have been implicated as a cause of neurologic dysfunction following surgery. 38 " 41 Muraoka et al 39 compared computerized tomographic scans of children undergoing open-heart surgery in 1981. The postoperative scans of a group of children undergoing bypass with a membrane oxygenator showed less abnormalities than those in whom a bubble oxygenator was used.…”

Section: Oxygenatorsmentioning

confidence: 99%

Neonatal cardiopulmonary bypass—a review of current practice in North America

et al. 1993

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One of the most challenging applications of cardiopulmonary bypass is corrective cardiac surgery in the neonate. The small size and high metabolic demand of these patients require miniaturized but efficient equipment. Even with the most advanced components, the volume required to prime the perfusion circuit is typically more than twice the blood volume of a neonate. Neonates have limited cardiac and pulmonary reserves and, therefore, great care is required to preserve those organs that have often already been subjected to hypoxemia, congestive heart failure, or low cardiac output prior to surgery. There is a tendency toward extravascular movement of fluids in newborns subjected to bypass that can adversely affect outcome. Careful monitoring and precise management of perfusion are essential to a successful procedure and optimal recovery of these patients.

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Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain

Cited by 87 publications

References 11 publications

Do blood levels of neuron‐specific enolase and S‐100 protein reflect cognitive dysfunction after coronary artery bypass?

Do blood levels of neuron‐specific enolase and S‐100 protein reflect cognitive dysfunction after coronary artery bypass?

Cerebral cellular response to profound hypothermia

Neonatal cardiopulmonary bypass—a review of current practice in North America

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