Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 1998
Comparative StudyCerebral complications after coronary artery bypass and heart valve surgery: risk factors and onset of symptoms.
Cerebral complications continue to be a major cause of morbidity after cardiac surgery. Earlier studies have mainly focused on intraoperative events, but symptoms may also occur later in the postoperative period. The purpose of this study was to determine the incidence and risk factors of focal neurologic complications and timing of cerebral symptoms. ⋯ Cerebral complications may be delayed after cardiac surgery, suggesting causes of cerebral damage other than intraoperative events. Valve-surgery patients had the lowest incidence and patients with combined procedures had the highest incidence of cerebral complications. Advanced age, diabetes mellitus, and preexisting cerebrovascular disease increased the risk.
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J. Cardiothorac. Vasc. Anesth. · Jun 1998
Comparative StudyEffect of aortic cannula characteristics and blood velocity on transcranial doppler-detected microemboli during cardiopulmonary bypass.
Cerebral microemboli are responsible to a large extent for the neuropsychiatric deficits after cardiac surgery. Differences in cannula size during cardiopulmonary bypass (CPB) will result in different velocities of blood exiting the aortic cannula. This study determined whether the number of transcranial Doppler (TCD)-detected emboli in the middle cerebral artery (MCA) during CPB correlated with blood speed or the direction of flow as determined by the shape of the aortic cannula. ⋯ The choice of a straight or curved aortic cannula or of a 24F versus 22F cannula may not be important with respect to the number of cerebral microemboli.
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J. Cardiothorac. Vasc. Anesth. · Jun 1998
Cardiac troponin I in diagnosis of perioperative myocardial infarction after cardiac surgery.
The diagnosis of perioperative myocardial infarction (PMI) after cardiac surgery remains an important issue. The present study was designed to determine the relevance of the measurement of serum cardiac troponin I (cTnI, a biochemical marker with high cardiospecificity. Therefore, cTnI was compared with creatine kinase-MB (CK-MB) mass and to the other classical signs of myocardial infarction after cardiac surgery. ⋯ A cTnI concentration less than 15 micrograms/L (mean + 2 standard deviations [SDs] of peak cTnI in group 3) within 24 to 48 hours after cardiac surgery is highly suggestive of the absence of perioperative myocardial necrosis. Because of its higher cardiospecificity than CK-MB mass, and its prolonged release after myocardial necrosis, cTnI might be a useful tool in the diagnosis of PMI after cardiac surgery.