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Neurologic Outcomes of Preoperative Acute Silent Cerebral Infarction in Patients with Cardiac Surgery

  • Sim, Hyung Tae (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital) ;
  • Kim, Sung Ryong (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital) ;
  • Beom, Min Sun (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital) ;
  • Chang, Ji Wook (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital) ;
  • Kim, Na Rae (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital) ;
  • Jang, Mi Hee (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital) ;
  • Ryu, Sang Wan (Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital)
  • Received : 2014.02.12
  • Accepted : 2014.08.07
  • Published : 2014.12.05

Abstract

Background: Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI. Methods: We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was $68.8{\pm}9.5$ years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies. Results: There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions. Conclusion: Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.

Keywords

References

  1. Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. Surgical management of infective endocarditis associated with cerebral complications: multi-center retrospective study in Japan. J Thorac Cardiovasc Surg 1995;110:1745-55. https://doi.org/10.1016/S0022-5223(95)70038-2
  2. Angstwurm K, Borges AC, Halle E, Schielke E, Einhaupl KM, Weber JR. Timing the valve replacement in infective endocarditis involving the brain. J Neurol 2004;251:1220-6. https://doi.org/10.1007/s00415-004-0517-x
  3. Thuny F, Avierinos JF, Tribouilloy C, et al. Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study. Eur Heart J 2007;28:1155-61. https://doi.org/10.1093/eurheartj/ehm005
  4. Ruttmann E, Willeit J, Ulmer H, et al. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke 2006;37:2094-9. https://doi.org/10.1161/01.STR.0000229894.28591.3f
  5. Maekawa K, Goto T, Baba T, Yoshitake A, Morishita S, Koshiji T. Abnormalities in the brain before elective cardiac surgery detected by diffusion-weighted magnetic resonance imaging. Ann Thorac Surg 2008;86:1563-9. https://doi.org/10.1016/j.athoracsur.2008.07.021
  6. Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology 2000;217:331-45. https://doi.org/10.1148/radiology.217.2.r00nv24331
  7. Vermeer SE, Longstreth Jr. WT, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol 2007;6:611-9. https://doi.org/10.1016/S1474-4422(07)70170-9
  8. Kim SJ, Shin HY, Ha YS, et al. Paradoxical embolism as a cause of silent brain infarctions in healthy subjects: the ICONS study (Identification of the Cause of Silent Cerebral Infarction in Healthy Subjects). Eur J Neurol 2013;20:353-60. https://doi.org/10.1111/j.1468-1331.2012.03864.x
  9. Omran H, Schmidt H, Hackenbroch M, et al. Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet 2003;361:1241-6. https://doi.org/10.1016/S0140-6736(03)12978-9
  10. Hamon M, Gomes S, Oppenheim C, et al. Cerebral microembolism during cardiac catheterization and risk of acute brain injury: a prospective diffusion-weighted magnetic resonance imaging study. Stroke 2006;37:2035-8. https://doi.org/10.1161/01.STR.0000231641.55843.49
  11. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC): endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009;30:2369-413. https://doi.org/10.1093/eurheartj/ehp285
  12. Goto T, Baba T, Honma K, et al. Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting. Ann Thorac Surg 2001;72:137-42. https://doi.org/10.1016/S0003-4975(01)02676-5
  13. Hosono M, Sasaki Y, Hirai H, et al. Considerations in timing of surgical intervention for infective endocarditis with cerebrovascular complications. J Heart Valve Dis 2010;19:321-5.

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  1. Incidence and Distribution of Cerebral Embolism After Cardiac Surgery According to the Systemic Perfusion Strategy ― A Diffusion-Weighted Magnetic Resonance Imaging Study― vol.84, pp.1, 2014, https://doi.org/10.1253/circj.cj-19-0654