The Annals of Thoracic Surgery, Vol 24, 34-37, Copyright © 1977 by The Society of Thoracic Surgeons
Calcium microemboli and microfilters in valve operations
TK Larmi, P Karkola, MI Kairaluoma, S Sutinen and A Partanen-Talsta
Fatal microemboli occurred in 3 of 100 consecutive patients having aortic
valve replacement; 2 occurred during perfusion before the microfilter era,
and 1 occurred intraoperatively despite the use of in- line filters. In all
3 patients cerebral symptoms were present immediately postoperatively, and
each died of severe brain damage. On postmortem examination cerebral
calcium microemboli were verified in only 2 patients, although the brain of
each patient contained minute infarctions. However, calcium particles were
found in the kidneys of all 3 patients. Thus the kidneys proved to be the
best place for detection of calcium emboli on postmortem examination.
Although the microfilters currently available effectively prevent
microemboli during extracorporeal circulation, the surgeon should be aware
that embolization can also occur immediately after discontinuation of
perfusion. The means of protecting the patient from this are discussed.
