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Most High-Intensity Transient Signals Are Not Associated With Specific Surgical Maneuvers.

Max H Twedt1, Benjamin D Hage1, James M Hammel2

  • 1Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA.

World Journal for Pediatric & Congenital Heart Surgery
|July 11, 2020
PubMed
Summary
This summary is machine-generated.

In infants undergoing heart surgery, most emboli detected are not linked to specific maneuvers. Aortic cross-clamp removal showed the highest emboli counts, suggesting a need for further research into embolic burden and neurological outcomes.

Keywords:
cardiopulmonary bypass (CPB)cerebral perfusioncerebral protectioncongenital heart disease (CHD)congenital heart surgeryembolismperioperative careultrasound (all applications)

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Area of Science:

  • Pediatric Cardiac Surgery
  • Neuroprotection
  • Medical Device Technology

Background:

  • Congenital heart defect surgery mortality has decreased significantly.
  • Research is focusing on preventing neurological issues linked to embolic burden.
  • The relationship between surgical actions and embolic burden in pediatric patients is poorly understood.

Purpose of the Study:

  • To investigate the correlation between specific surgical maneuvers and embolic burden in infants undergoing congenital heart defect repair.
  • To assess the utility of Transcranial Doppler ultrasound in monitoring emboli during pediatric cardiac surgery.

Main Methods:

  • Continuous monitoring of middle cerebral artery blood flow using Transcranial Doppler ultrasound in 20 infants.
  • Recording of embolus counts (high-intensity transient signals - HITS) associated with specific surgical maneuvers from sternal incision to chest closure.

Main Results:

  • Only 13% of detected HITS were definitively linked to specific surgical maneuvers.
  • Aortic cross-clamp removal was associated with the highest mean number of HITS.
  • Aortic cross-clamp placement also showed significantly elevated HITS counts compared to other maneuvers.

Conclusions:

  • The majority of detected emboli during infant cardiac surgery are not definitively linked to specific maneuvers.
  • Aortic cross-clamp removal is associated with the highest occurrence of HITS.
  • Further research is recommended to identify other emboli sources and study the impact of embolic burden on long-term neurological outcomes.