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Brain embolic phenomena associated with cardiopulmonary bypass
V R Challa1, D M Moody, B T Troost
1Department of Pathology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157.
Journal of the Neurological Sciences
|July 1, 1993
Summary
Non-biologic materials, like Antifoam A, may cause small capillary and arteriolar dilatations (SCADs) after open heart surgery. These SCADs are potential embolic phenomena requiring further investigation into their source and composition.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Histopathology
Background:
- Cardiopulmonary bypass (CPB) in open heart surgery can lead to brain emboli from various materials.
- Non-biologic materials, including Antifoam A (organosilicates/silicon), are used in CPB.
- While large emboli and stroke are reduced, other unexplained neurologic issues persist post-surgery.
Purpose of the Study:
- To investigate potential embolic phenomena in the brain following open heart surgery with CPB.
- To identify the nature and source of embolic materials contributing to post-operative neurologic sequelae.
Main Methods:
- Post-mortem brain tissue analysis from patients and dogs undergoing CPB surgery.
- Utilized a histochemical technique for endothelial alkaline phosphatase (AP) demonstration.
- Employed light microscopy and microradiography on AP-stained celloidin sections.
Main Results:
- Identified small capillary and arteriolar dilatations (SCADs) exclusively in CPB-subjected brains, not controls.
- SCADs were observed throughout the brain parenchyma.
- Approximately 50% of SCADs exhibited birefringence under polarized light, suggesting crystalline or organized material.
Conclusions:
- SCADs represent a potential embolic phenomenon linked to open heart surgery with CPB.
- Preliminary findings suggest a glycolipid component in the embolic material.
- The precise nature and origin of these emboli remain under investigation, as the material is often dissolved during tissue processing.