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Related Experiment Videos

Transmyocardial laser revascularization induces cerebral microembolization

G von Knobelsdorff1, P Brauer, P H Tonner

  • 1Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany.

Anesthesiology
|July 1, 1997
PubMed
Summary

Transmyocardial laser revascularization can cause microemboli in the middle cerebral artery. However, these cerebral emboli did not affect blood flow velocity or oxygen saturation, suggesting no global oxygen imbalance.

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Medical Imaging

Background:

  • Transmyocardial laser revascularization (TMLR) may lead to fluid vaporization in the left heart, potentially causing bubble formation.
  • The formation of cerebral emboli during TMLR is a concern that requires investigation.

Purpose of the Study:

  • To determine if laser pulses during TMLR generate cerebral emboli.
  • To assess changes in middle cerebral artery flow velocity and jugular bulb oxygen saturation (SjO2) during TMLR.

Main Methods:

  • Twelve patients (ASA physical status III) were monitored for hemodynamic and respiratory parameters.
  • Transesophageal sonography and transcranial Doppler sonography were used to detect intraventricular events and middle cerebral artery (MCA) flow velocity (Vmean).

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  • Jugular bulb oxygen saturation (SjO2) was measured using a fiberoptic thermodilution catheter.

    • Main Results:

    • Transesophageal sonography revealed intraventricular echogenic contrast after laser injection.
    • Transcranial Doppler sonography detected high-intensity signals (microemboli) in the MCA 2-4 seconds post-injection.
    • No significant changes in Vmean or SjO2 were observed when mean arterial pressure remained stable.

    Conclusions:

    • Microemboli can be detected in the middle cerebral artery following laser injection during TMLR.
    • These microemboli did not induce significant changes in Vmean or SjO2.
    • The findings suggest that TMLR-induced microemboli do not cause a global oxygen imbalance.