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Ann Thorac Surg 1995;59:1304-1307
© 1995 The Society of Thoracic Surgeons

Articles

Brain microemboli associated with cardiopulmonary bypass: A histologic and magnetic resonance imaging study

MD Dixon M. Moodya,b,*, PhD William R. Browna,b, MD Venkata R. Challaa,b, PhD David A. Stumpa,b, PhD David M. Reboussina,b, PhD Claudine Legaulta,b

a Departments of Radiology, Pathology, Anesthesiology, and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA
b Program in Neuroscience, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA

* Address reprint requests to Dr Moody, Division of Radiologic Sciences, Department of Radiology, Bowman Gray School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1088.

Emboli in brain tissue after cardiopulmonary bypass were reported in the literature 30 years ago, but there is little objective evidence confirming the presence of emboli in the brain after cardiopulmonary bypass with more modern equipment and techniques. Recently, with alkaline phosphatase vascular staining, we found an acellular fatty material in brain microvasculature from autopsy material of patients who died shortly after cardiopulmonary bypass. These fatty intravascular collections range in diameter from 10 to 70 µm, a size that lodges in the smallest vessels of the microvasculature. They have been found in numbers sufficient to cause detectable neurologic dysfunction and are believed, but not proved, to be emboli. By sequentially injecting colored microspheres, we can determine when emboli occur during experimental cardiopulmonary bypass. In ongoing related studies, magnetic resonance imaging was performed before cardiac valve replacement in 39 patients for whom preoperative and postoperative neurologic and neuropsychologic testing was available. Preliminary results suggest that magnetic resonance imaging evidence of prior stroke is not a significant risk factor for cognitive or motor decrement after cardiopulmonary bypass.




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