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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Cerebral emboli during cardiac surgery in children
J J O'Brien1, J Butterworth, J W Hammon
1Department of Anesthesiology, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1009, USA. jobrian@bgsm.edu
Anesthesiology
|November 20, 1997
Summary
Microemboli are common during pediatric cardiac surgery, particularly after aortic crossclamp release. Their link to neurological deficits in children needs further investigation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Neurology
Background:
- Microemboli are linked to neuropsychological deficits in adult cardiac surgery.
- The incidence and significance of microemboli in pediatric congenital heart disease repair are unknown.
- Hypothesis: Microemboli occur before bypass in children with right-to-left shunts and increase upon aortic crossclamp release.
Purpose of the Study:
- To investigate the occurrence and timing of microemboli during congenital heart defect repair in children.
- To compare microemboli incidence in high-risk versus low-risk patient groups.
Main Methods:
- Carotid artery Doppler used to detect and count embolic signals in 25 children.
- Patients categorized into high-risk (obligate right-to-left shunt) and low-risk (net left-to-right shunt) groups.
- Emboli timing correlated with 13 intraoperative events.
Main Results:
- A median of 122 microemboli were detected (range, 2-2,664).
- 42% of emboli occurred within 3 minutes of aortic crossclamp release.
- High-risk group showed significantly more emboli before bypass (median 66) than low-risk (median 8).
Conclusions:
- Microemboli are detectable in pediatric congenital heart disease repair, especially after aortic crossclamp release.
- The specific role of these microemboli in causing neurological injury in children requires further study.
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