The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 3 , Pages 512-520 , March 2008

Solid and gaseous cerebral microembolization after biologic and mechanical aortic valve replacement: Investigation with multirange and multifrequency transcranial Doppler ultrasound

Received 17 March 2007 ,Revised 8 July 2007 ,Accepted 10 July 2007.

References 

  1. Schumann H, Feigenbaum H, Dillon JC, Chang S. Intracavitary echoes in patients with prosthetic valves. J Clin Ultrasound. 1975;3:107–110
  2. Rams JJ, Davis DA, Lolley DM, Berger MP, Spencer M. Detection of microemboli in patients with artificial heart valves using transcranial Doppler: preliminary observations. J Heart Valve Dis. 1993;2:37–41
  3. Muller HR, Burckhardt D, Casty M, Pfisterer ME, Buser MW. High intensity transcranial Doppler signals (HITS) after prosthetic valve implantation. J Heart Valve Dis. 1994;3:602–606
  4. Braekken SK, Russell D, Brucher R, Svennevig J. Incidence and frequency of cerebral embolic signals in patients with a similar bileaflet mechanical heart valve. Stroke. 1995;26:1225–1230
  5. Georgiadis D, Wenzel A, Lehmann D, Lindner A, Zerkowski HR, Zierz S, et al. Influence of oxygen ventilation on Doppler microemboli signals in patients with artificial heart valves. Stroke. 1997;28:2189–2194
  6. Sliwka U, Georgiadis D. Clinical correlation of Doppler microembolic signals in patients with prosthetic cardiac valves- analysis of 580 cases. Stroke. 1998;29:140–143
  7. Milano A, D’Alfonso A, Codecasa R, De Carlo M, Nardi C, Orlandi G, et al. Prospective evaluation of frequency and nature of transcranial high-intensity Doppler signals in prosthetic valve recipients. J Heart Valve Dis. 1999;8:488–494
  8. Baumgartner RW, Frick A, Kremer C, Oechslin E, Russi E, Turina J, et al. Microembolic signal counts increase during hyperbaric exposure in patients with prosthetic heart valves. J Thorac Cardiovasc Surg. 2001;122:1142–1146
  9. Uekermann J, Suchan B, Kseibi S, Perthel M, Laas J. Neuropsychological deficits after mechanical aortic valve replacement. J Heart Valve Dis. 2005;14:338–343
  10. Grosset DG, Cowburn P, Georgiadis D, Dargie HJ, Faichney A, Lee KR. Ultrasound detection of cerebral microemboli in patients with prosthetic heart valves. J Heart Valve Dis. 1994;3:128–132
  11. Lievense AM, Bakker SL, Dippel DW, Taams MA, Koudstaal PJ, Bogers AJ. Intracranial high-intensity transient signals after homograft or mechanical aortic valve replacement. J Cardiovasc Surg (Torino). 1998;39:613–617
  12. Notzold A, Droste DW, Hagedorn G, Berndt S, Kaps M, Graf B, et al. Circulating microemboli in patients after aortic valve replacement with pulmonary autografts and mechanical valve prostheses. Circulation. 1997;96:1843–1846
  13. Stump DA, Tegeler CH, Rogers AT, Coker LH, Newman SP, Wallenhaupt SL, et al. Neuropsychological deficits are associated with the number of emboli detected during cardiac surgery. Stroke. 1993;24:509;(abstract presented to the 7th International Symposium on Cerebral Hemodynamics)
  14. Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke. 1994;25:1393–1399
  15. Stump DA, Rogers AT, Hammon JW, Newman SP. Cerebral emboli and cognitive outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 1996;10:113–119
  16. Sylivris S, Levi C, Matalanis G, Rosalion A, Buxton BF, Mitchell A, et al. Pattern and significance of cerebral microemboli during coronary artery bypass grafting. Ann Thorac Surg. 1998;66:1674–1678
  17. Abu-Omar Y, Cifelli A, Matthews PM, Taggart DP. The role of microembolisation in cerebral injury as defined by functional magnetic resonance imaging. Eur J Cardiothorac Surg. 2004;26:586–591
  18. Abu-Omar Y, Cader S, Guerrieri Wolf L, Pigott D, Matthews PM, Taggart DP. Short-term changes in cerebral activity in on-pump and off-pump cardiac surgery defined by functional magnetic resonance imaging and their relationship to microembolization. J Thorac Cardiovasc Surg. 2006;132:1119–1125
  19. Deklunder G, Roussell M, Lecroart JL, Prat A, Gautier C. Microemboli in cerebral circulation and alteration of cognitive abilities in patients with mechanical prosthetic heart valves. Stroke. 1998;29:1821–1826
  20. Nadareishvili ZG, Beletsky V, Black SE, Fremes SE, Freedman M, Kurzman D, et al. Is cerebral microembolism in mechanical prosthetic heart valves clinically relevant?. J Neuroimaging. 2002;12:310–315
  21. Kaps M, Hansen J, Weiher M, Tiffert K, Kayser I, Droste DW. Clinically silent microemboli in patients with artificial prosthetic aortic valves are predominantly gaseous and not solid. Stroke. 1997;28:322–325
  22. Kofidis T, Fischer S, Leyh R, Mair H, Deckert M, Haberl R, et al. Clinical relevance of intracranial high intensity transient signals in patients following prosthetic aortic valve replacement. Eur J Cardiothorac Surg. 2002;21:22–26
  23. MacKay TG, Georgiadis D, Grosset DG, Lees KR, Wheatley DJ. On the origin of cerebrovascular microemboli associated with prosthetic heart valves. Neurosci Res. 1995;17:349–352
  24. Laas J, Kseibi S, Perthel M, Klingbeil A, El-Ayoubi L, Alken A. Impact of high intensity transient signals on the choice of mechanical aortic valve substitutes. Eur J Cardiothorac Surg. 2003;23:93–96
  25. Georgiadis D, Kaps M, Berg J, MacKay TG, Dapper F, Faichney A, et al. Transcranial Doppler detection of microemboli in prosthetic heart valve patients: dependency upon valve type. Eur J Cardiothorac Surg. 1996;10:253–257
  26. Kleine P, Perthel M, Hasenkam JM, Nygaard H, Hansen SB, Laas J. Downstream turbulence and high intensity transient signals (HITS) following aortic valve replacement with Medtronic Hall or St (Jude Medical valve substitutes). Eur J Cardiothorac Surg. 2000;17:20–24
  27. Deklunder G, Lecroart JL, Conger JL, Lapeyre D, Gregoric I, Rose H, et al. Effects of myocardial contractility on microemboli production by mechanical heart valves in a bovine model. Tex Heart Inst J. 2000;27:236–239
  28. Bluestein D, Li YM, Krukenkamp IB. Free emboli formation in the wake of bi-leaflet mechanical heart valves and the effects of implantation techniques. J Biomech. 2002;35:1533–1540
  29. Hiratsuka R, Fukunaga S, Tayama E, Takagi K, Arinaga K, Shojima T, et al. High-intensity transient signals due to prosthetic valve obstruction: diagnostic and therapeutic implications. Ann Thorac Surg. 2004;77:1615–1621
  30. Droste DW, Hansberg T, Kemeny V, Hammel D, Schulte-Altedorneburg G, Nabavi DG, et al. Oxygen inhalation can differentiate gaseous from non gaseous microemboli detected by transcranial Doppler ultrasound. Stroke. 1997;28:2453–2456
  31. Steinberg GK, De La Paz R, Mitchell SM, Bell TE, Albers GW. MRI and cerebrospinal fluid enzymes as sensitive indicators of subclinical cerebral injury after open-heart valve replacement surgery. Am J Neuroradiol. 1996;17:205–212
  32. Hills BA, James PB. Microbubble damage to the blood-brain barrier: relevance to decompression sickness. Undersea Biomed Res. 1991;18:111–116
  33. Brucher R, Russell D. Automatic online embolus detection and artifact rejection with the first multifrequency transcranial Doppler. Stroke. 2002;33:1969–1974
  34. Russell D, Brucher R. Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler. Stroke. 2002;33:1975–1980
  35. Laas J, Kleine P, Hasenkam MJ, Nygaard H. Orientation of tilting disc and bileaflet aortic valves substitutes for optimal hemodynamics. Ann Thorac Surg. 1999;68:1096–1099
  36. Georgiadis D, Baumgartner RW, Karatschai R, Lindner A, Zerkowski HR. Further evidence of gaseous embolic material in patients with artificial heart valves. J Thorac Cardiovasc Surg. 1998;115:808–810
  37. Dauzat M, Deklunder G, Aldis A, Rabinovitch R, Burte F, Bret PM. Gas bubble emboli detected by transcranial Doppler sonography in patients with prosthetic heart valves: a preliminary report. J Ultrasound Med. 1994;13:129–135
  38. Georgiadis D, Mallinson A, Grosset DG, Lees KR. Emboli signals and coagulation activity in patients with prosthetic heart valves. Stroke. 1994;25:1211–1214
  39. Georgiadis D, MacKay TG, Kelman AW, Grosset DG, Wheatley DJ, Lees KR. Differentiation between gaseous and formed embolic materials in vivo (Application in prosthetic heart valve patients). Stroke. 1994;25:1559–1563
  40. Raco L, Belcher PR, Sim I, McGarrity A, Bernacca GM, Wheatley DJ. Platelet aggregation and high intensity transient signals (HITS) in a sheep model of mitral valve replacement. J Heart Valve Dis. 1999;8:476–481
  41. Geiser T, Sturzenegger M, Genewein U, Haeberli A, Beer JH. Mechanisms of cerebrovascular events as assessed by procoagulant activity, cerebral microemboli, and platelet microparticles in patients with prosthetic heart valves. Stroke. 1998;29:1770–1777
  42. Sturzenegger M, Beer JH, Rihs F. Monitoring combined antithrombotic treatments in patients with prosthetic heart valves using transcranial Doppler and coagulation markers. Stroke. 1995;26:63–69
  43. Markus HS, Punter M. Can transcranial Doppler discriminate between solid and gaseous microemboli? (Assessment of a dual-frequency transducer system). Stroke. 2005;36:1731–1734
  44. Russell D, Brucher R. Embolus detection and differentiation using multifrequency transcranial Doppler. Stroke. 2005;36:706
  45. Turpie AG, Gent M, Laupacis A, Latour Y, Gunstensen J, Basile F, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med. 1993;329:524–529
  46. Little SH, Massel DR. Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev. 2003;CD003464
  47. Zimpfer D, Kilo J, Czerny M, Kasimir MT, Madl C, Bauer E, et al. Neurocognitive deficit following aortic valve replacement with biological/mechanical prosthesis. Eur J Cardiothorac Surg. 2003;23:544–551
  48. Zimpfer D, Czerny M, Schuch P, Fakin R, Madl C, Wolner E, et al. Long- term neurocognitive function after mechanical aortic valve replacement. Ann Thorac Surg. 2006;81:29–33

PII: S0022-5223(07)01539-5

doi: 10.1016/j.jtcvs.2007.07.062

The Journal of Thoracic and Cardiovascular Surgery
Volume 135, Issue 3 , Pages 512-520 , March 2008

Article Tools

* Image Usage & Resolution