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Extracorporeal circulation before and after ultrasonographic evaluation of the ascending aorta
1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Japan.
Insights
New intimal lesions after extracorporeal circulation, particularly mobile types, frequently lead to postoperative stroke. Surgical techniques should be modified to prevent these lesions during cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Atheroembolization mechanisms are not fully understood.
- Epiaortic echocardiography can evaluate these mechanisms.
- Pre- and post-cardiac surgery evaluation is crucial.
Purpose of the Study:
- To investigate the incidence and impact of new intimal lesions after extracorporeal circulation.
- To correlate these lesions with postoperative stroke.
- To inform surgical technique modifications.
Main Methods:
- Epiaortic two-dimensional echocardiography was used.
- 188 patients undergoing cardiac surgery with extracorporeal circulation were studied.
- Evaluations were performed before cannulation and after decannulation.
Main Results:
- New intimal lesions were identified in 5.3% of patients post-decannulation.
- Mobile type lesions were associated with a high stroke rate (60%).
- Fewer strokes occurred in patients without new lesions (1.1%).
Conclusions:
- Clamp- or cannula-induced intimal lesions, especially mobile types, are linked to postoperative stroke.
- Surgical technique modifications are recommended to minimize lesion formation.
- Preventing mobile intimal lesions may reduce stroke incidence.
Background:
To further gain insight into atheroembolization mechanisms epiaortic two-dimensional echocardiographic evaluation before extracorporeal circulation and after decannulation may be helpful.
Methods:
Epiaortic two-dimensional echocardiography was performed before cannulation and after decannulation in 188 (124 men) patients (mean age, 67.7 years; range, 43 to 86 years) undergoing operation with extracorporeal circulation for ischemic heart disease during 1996.
Results:
After decannulation, a new intimal lesion was recognized in 10 of 188 patients (5.3%): mobile type in 5 patients (3 ending with a stroke [60%], 2 having brain computed tomographic scans compatible with embolism), intimal tear in 2, and intimal irregularity in 3 patients. Stroke occurred in a significantly smaller number of patients (2 of 178 [1.1%]; p < 0.001) without new lesions.
Conclusions:
Clamp- or cannula-induced new lesions, especially of mobile type, are often complicated by postoperative stroke. Aggressive surgical technique modifications may need to be considered to avoid creating new lesions, particularly of the mobile type.