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The effect of coronary artery bypass surgery on brain perfusion
B Degirmenci1, H Durak, E Hazan
1Department of Nuclear Medicine, Dokuz Eylül University School of Medicine, Izmir, Turkey.
Insights
Coronary artery bypass grafting (CABG) can lead to neuropsychological issues due to brain perfusion changes. Technetium-99m-HMPAO brain SPECT imaging identified frontal hypoperfusion in patients experiencing these complications after surgery.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Coronary artery bypass grafting (CABG) is a primary treatment for coronary artery disease, often involving cardiopulmonary bypass (CPB).
- Neurological and neuropsychological complications are known sequelae following CPB.
- Evaluating brain perfusion changes is crucial for understanding these post-surgical complications.
Purpose of the Study:
- To assess brain perfusion patterns before and after cardiopulmonary bypass (CPB) in patients undergoing open-heart surgery.
- To identify specific brain perfusion changes associated with neurological and neuropsychological complications post-CPB.
- To evaluate the utility of Technetium-99m-HMPAO brain SPECT in detecting these changes.
Main Methods:
- A cohort of 25 patients (22 CABG, 3 valve replacement) and 5 controls underwent brain perfusion SPECT imaging using 99mTc-HMPAO.
- Imaging was performed one week pre-surgery and 4-6 weeks post-surgery.
- SPECT images were analyzed visually and semiquantitatively to assess regional brain perfusion.
Main Results:
- Eight patients experienced post-CABG neuropsychological deficits, including cognitive deterioration, depressive mood, disorientation, agitation, and confusion.
- These symptomatic patients showed significant frontal hypoperfusion (p = 0.0277) and left parietal hypoperfusion (p = 0.0277) on SPECT.
- No perfusion abnormalities were detected in asymptomatic patients or the control group. Follow-up SPECT in two patients showed normalization of frontal hypoperfusion with symptom resolution.
Conclusions:
- Regional cortical hypoperfusion, particularly in the frontal regions, is associated with neuropsychological complications following CABG.
- Technetium-99m-HMPAO brain SPECT is an effective diagnostic tool for identifying and locating brain perfusion alterations after CABG.
- These findings highlight the potential for reversible brain perfusion deficits contributing to post-cardiac surgery neuropsychological issues.
Unlabelled:
Coronary artery bypass grafting (CABG) is one of the major treatment methods of coronary artery disease. CABG is an open-heart surgery that uses cardiopulmonary bypass (CPB). After CPB, it is well known that neurological and neuropsychological complications may occur. The purpose of this study was to evaluate brain perfusion patterns before and after CPB and to locate brain perfusion changes in patients with neurological and neuropsycological complications after CPB.
Methods:
Twenty-five patients who underwent open-heart surgery (22 CABG, 3 valve replacement) and 5 patients (4 cholecystectomy, 1 periferic vascular surgery) as a control group were included in the study. The 99mTc-HMPAO injected dose was 925 MBq. Brain perfusion SPECT images were obtained 30-60 min postinjection using a dedicated triple-head brain SPECT camera. Imaging was performed 1 wk before and 4-6 wk after surgery. Technetium-99m-HMPAO brain SPECT slices were evaluated visually and semiquantitatively.
Results:
None of the patients had severe neurologic complications. Neuropsychological deficits occurred in eight patients after CABG. Cognitive deterioration and depressive mood occurred in five patients. Disorientation, agitation and confusion periods were present in another two patients. Frontal hypoperfusion was found in these patients by visual and semiquantitative evaluations (p = 0.0277) and left parietal hypoperfusion was also present semiquantitatively (p = 0.0277). Visual hallucinations occurred in one patient. Computed tomography of these patients was normal. No perfusion abnormalities were observed in the patient with visual hallucinations and in patients without symptoms after open-heart surgery nor in the control group. Brain SPECT was repeated in two symptomatic patients 5 mo after CABG. Frontal hypoperfusion became normal, and these patients' symptoms disappeared.
Conclusion:
The results of this study indicate that regional cortical hypoperfusion may occur in patients with neuropsychological complications after CABG. Technetium-99m-HMPAO brain SPECT is a useful method to locate and determine brain perfusion changes after CABG.