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Brain microemboli associated with cardiopulmonary bypass: a histologic and magnetic resonance imaging study
D M Moody1, W R Brown, V R Challa
1Department of Radiology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1088, USA.
Abstract:
Emboli in brain tissue after cardiopulmonary bypass were reported in the literature 30 years ago, but there is little objective evidence confirming the presence of emboli in the brain after cardiopulmonary bypass with more modern equipment and techniques. Recently, with alkaline phosphatase vascular staining, we found an acellular fatty material in brain microvasculature from autopsy material of patients who died shortly after cardiopulmonary bypass. These fatty intravascular collections range in diameter from 10 to 70 microns, a size that lodges in the smallest vessels of the microvasculature. They have been found in numbers sufficient to cause detectable neurologic dysfunction and are believed, but not proved, to be emboli. By sequentially injecting colored microspheres, we can determine when emboli occur during experimental cardiopulmonary bypass. In ongoing related studies, magnetic resonance imaging was performed before cardiac valve replacement in 39 patients for whom preoperative and postoperative neurologic and neuropsychologic testing was available. Preliminary results suggest that magnetic resonance imaging evidence of prior stroke is not a significant risk factor for cognitive or motor decrement after cardiopulmonary bypass.
Insights
Fatty emboli in brain microvasculature after cardiopulmonary bypass are confirmed. These findings suggest a potential cause for neurologic dysfunction following cardiac surgery.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Pathology
Background:
- Emboli in brain tissue post-cardiopulmonary bypass (CPB) have been historically documented.
- Objective evidence confirming emboli in modern CPB procedures is limited.
Purpose of the Study:
- To investigate the presence and nature of emboli in the brain microvasculature after CPB.
- To explore the potential link between these emboli and neurologic dysfunction.
- To assess the role of prior stroke as a risk factor for cognitive decline post-CPB.
Main Methods:
- Autopsy analysis of brain microvasculature using alkaline phosphatase vascular staining to identify acellular fatty material.
- Experimental CPB using colored microspheres to determine emboli occurrence.
- Magnetic resonance imaging (MRI) and pre/postoperative neurologic and neuropsychologic testing in patients undergoing cardiac valve replacement.
Main Results:
- Acellular fatty material, ranging from 10 to 70 microns, was identified in the brain microvasculature of patients deceased shortly after CPB.
- These fatty emboli were found in sufficient numbers to potentially cause detectable neurologic dysfunction.
- Preliminary MRI data suggest that pre-existing stroke is not a significant predictor of cognitive or motor deficits after CPB.
Conclusions:
- Objective evidence supports the presence of fatty emboli in the brain microvasculature following CPB.
- These emboli are a plausible cause of neurologic dysfunction after cardiac surgery.
- Further research is needed to fully elucidate the mechanisms and clinical implications of these findings.
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