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The Annals of Thoracic Surgery, Vol 51, 237-241, Copyright © 1991 by The Society of Thoracic Surgeons
J van der Linden and H Casimir-Ahn
The transcranial Doppler technique enabled the detection of cerebral air
emboli in 10 of 10 patients during open-heart valve operations despite
standard deairing procedures. With this technique, the occurrence of emboli
in the right middle cerebral artery was followed continuously in patients
undergoing aortic or mitral valve replacement. Membrane oxygenators were
used. Scattered emboli were observed during the insertion of the aortic
cannula, at the start of cardiopulmonary bypass, and after the declamping
of the aorta with the heart beating while empty. During the period of
aortic cross-clamping, no emboli were detected. Despite careful deairing
procedures, the recordings indicated a large amount of emboli during
filling of the empty beating heart in all 10 patients. Thus, this study
indicates that cerebral emboli in open heart procedures are most likely to
occur during the redistribution of blood from the heart-lung machine to the
patient when the heart is beginning to eject actively, despite careful
standard deairing procedures. Meticulous deairing before declamping the
aorta is strongly advocated. In addition, a short period of filling of the
beating heart before final closure of the aortic incision or vent may
decrease the incidence of cerebral emboli. A concomitant reduction in
cerebral blood flow by hyperventilation or anesthetics or both during
filling of the empty beating heart may also be beneficial.
ARTICLES
When do cerebral emboli appear during open heart operations? A transcranial Doppler study
Department of Anesthesia and Intensive Care, University Hospital, Uppsala, Sweden.
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D. Barbut, Y.-W. Lo, J. P. Gold, R. R. Trifiletti, F. S. Frank Yao, D. N. Hager, R. B. Hinton, and O. W. Isom Impact of Embolization During Coronary Artery Bypass Grafting on Outcome and Length of Stay Ann. Thorac. Surg., April 1, 1997; 63(4): 998 - 1002. [Abstract] [Full Text]
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J Johnson and J B Desai Fingertip temperature during cardiopulmonary bypass Perfusion, March 1, 1997; 12(2): 120 - 126. [Abstract] [PDF]
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F. Dexter, B. J Hindman, and J. S Marshall Estimate of the maximum absorption rate of microscopic arterial air emboli after entry into the arterial circulation during cardiac surgery Perfusion, November 1, 1996; 11(6): 445 - 450. [Abstract] [PDF]
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M. F. Pompili, J. H. Stevens, T. A. Burdon, L. C. Siegel, W. S. Peters, G. H. Ribakove, and B. A. Reitz PORT-ACCESS MITRAL VALVE REPLACEMENT IN DOGS J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1268 - 1274. [Abstract] [Full Text]
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G. Grieco, M. d'Hollosy, A. T. Culliford, and S. Jonas Evaluating Neuroprotective Agents for Clinical Anti-Ischemic Benefit Using Neurological and Neuropsychological Changes After Cardiac Surgery Under Cardiopulmonary Bypass : Methodological Strategies and Results of a Double-Blind, Placebo-Controlled Trial of GM1 Ganglioside Stroke, May 1, 1996; 27(5): 858 - 874. [Abstract] [Full Text]
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K. H. Ryu, B. J. Hindman, D. K. Reasoner, and F. Dexter Heparin Reduces Neurological Impairment After Cerebral Arterial Air Embolism in the Rabbit Stroke, February 1, 1996; 27(2): 303 - 310. [Abstract] [Full Text]
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M. Kurusz, B. D Butler, J. Katz, and V. R Conti Air embolism during cardiopulmonary bypass Perfusion, November 1, 1995; 10(6): 361 - 391. [PDF]
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E. A. Tovar, C. D. Campo, A. Borsari, R. P. Webb, J. R. Dell, and P. B. Weinstein Postoperative Management of Cerebral Air Embolism: Gas Physiology for Surgeons Ann. Thorac. Surg., October 1, 1995; 60(4): 1138 - 1142. [Abstract] [Full Text]
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J. Tingleff, F. S. Joyce, and G. Pettersson Intraoperative Echocardiographic Study of Air Embolism During Cardiac Operations Ann. Thorac. Surg., September 1, 1995; 60(3): 673 - 677. [Abstract] [Full Text]
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A. J. Baker, B. Naser, M. Benaroia, and C. D. Mazer Cerebral Microemboli During Coronary Artery Bypass Using Different Cardioplegia Techniques Ann. Thorac. Surg., May 1, 1995; 59(5): 1187 - 1191. [Abstract] [Full Text]
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R. E. Clark, J. Brillman, D. A. Davis, M. R. Lovell, T. R. P. Price, and G. J. Magovern MD Microemboli during coronary artery bypass grafting: Genesis and effect on outcome J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 249 - 258. [Abstract] [Full Text]
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