Evidence suggestive of diffuse brain damage following cardiac operations

In 37 patients regional cerebral blood flow (rCBF) was measured by single photon emission computerised tomography (SPECT) after inhalation of xenon-133 before and within the first 10 days after open heart surgery for acquired or congenital heart disease. None of the patients had motor deficits postoperatively and no focal abnormalities were disclosed by the rCBF tomograms. However, rCBF was generally reduced and mean CBF fell from a normal value of 53.5 to 44.7 ml/100 g X min (p less than 0.001). Changes in rCBF occurred uniformly throughout the brain. The reduction in CBF correlated positively with increasing years (p less than 0.05), duration of extracorporeal circulation (p less than 0.05), and low mean arterial blood pressure during the bypass (p less than 0.02). It was generally more pronounced after valve replacement than after coronary bypass (p less than 0.16). In 11 patients investigated 1 year after surgery CBF remained slightly reduced, 50.5 ml/100 g X min (p less than 0.05). No CBF reduction occurred in a control group of 15 patients who underwent carotid endarterectomy or extracranial-intracranial shunt operations. The findings are consistent with the suggestion that the extracorporeal circulation causes early postoperative central nervous system dysfunction.