Microembolic signals in patients undergoing coronary artery bypass grafting: Effect of aortic atherosclerosis

• Published in: Texas Heart Institute journal 2001, Vol.28 (1), p.16-20
• Main Authors: KUMRAL, Emre, BALKIR, Kaan, YAGDI, Tahir, KARA, Erkan, EVYAPAN, Dilek, BILKAY, Önol
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - pathology; Aortic Diseases - diagnostic imaging; Aortic Diseases - pathology; Aortic Diseases - surgery; Biological and medical sciences; Clinical Investigation; Coronary Artery Bypass; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary Artery Disease - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Echocardiography, Doppler; Echocardiography, Transesophageal; Female; Humans; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - etiology; Male; Medical sciences; Middle Aged; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 0730-2347; 1526-6702

The aim of this prospective study was to determine whether aortic atherosclerotic plaques are associated with increased frequency of microembolic signals and stroke in patients who undergo coronary artery bypass grafting. A total of 69 such patients were monitored by transcranial Doppler ultrasonography for 30 minutes before and after surgery. To our knowledge, this study is the 1st in which in vivo pathologic analysis of aortic plaques was systematically performed-and microembolic signals monitored-before and after open-heart surgery. Plaques were assessed by transesophageal echocardiography and by biopsy of materials taken during surgery. The frequency of microembolic signals was evaluated with regard to the occurrence of postoperative stroke. In the preoperative phase, only 10 of 48 patients with aortic plaques had microembolic signals, and the mean count of microembolic signals was 3.2 +/- 1.2 per hour. At the conclusion of 24 postoperative hours, 29 patients (42%) displayed such signals (mean count, 9.8 +/- 3.1/h). Seven of the 48 patients (15%) with aortic atherosclerosis had cerebral ischemic events, but none of those with normal aorta (21 patients) experienced stroke during the postoperative phase. During postoperative monitoring, patients with stroke had higher microembolic-signal counts than did those with normal aorta (174 +/- 3.3/h vs 5.9 +/- 3.1/h; P