Brain damage after open heart surgery in patients with acute cardioembolic stroke.
Open accessAbstract
We evaluated 14 patients with acute cardiogenic embolism who underwent open heart surgery soon after the onset to determine the cerebral and cardiac factors that influence neurologic outcome. The mean interval from onset of cerebral embolism to surgery was 5.3 (range 1-16) days. Five of the 14 patients had vegetations from infective endocarditis (including prosthetic valve endocarditis) as embolic sources, eight had intracardiac thrombi, and one had atrial myxoma. The diagnosed site of infarction before surgery was based on computed tomographic and/or angiographic findings. Of the 14 patients, four had infarcts due to major artery occlusion, seven due to cortical branch occlusion, and two due to perforating artery occlusion; one patient presented with a transient ischemic attack without computed tomographic abnormalities. Ten patients (71%) showed no clinical aggravation after open heart surgery; however, two patients died of massive cerebral hemorrhage, one died of deterioration of brain edema, and another became comatose from midbrain hemorrhage immediately after surgery. The four patients with clinical aggravation comprised three with septic embolism and one with aseptic occlusion of a major artery. From these results, infective endocarditis and a large infarct appear to be possible aggravating factors when patients with recent cerebral embolism undergo open heart surgery.
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The high rates of postoperative morbidity and mortality seen in earlier studies have resulted in a reluctance to refer patients with infective endocarditis and acute stroke for immediate valve surgery.
“The high rates of postoperative morbidity and mortality seen in earlier studies [265][266][267] have resulted in a reluctance to refer patients with IE and acute stroke for immediate valve surgery.”
These initial studies included a limited number of patients, and risk adjustments were not performed.
“However, these initial studies included a limited number of patients, and risk adjustments were not performed.”
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References 12 · Cited by 68
Research works printed but not linked: 5
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- [7]7. Choki J, Yamaguchi T, Hirata Y, Tashiro M, Sawada T: Clinical features of cerebral embolism: Analysis of 48 cases in the acute stage. Jpn J Stroke 1982;4:54-62
- [9]9. Cerebral Embolism Study Group: Immediate anticoagula- tion of embolic stroke: A randomized trial. Stroke 1983; 14:668-676
- [13]13. Shields RW Jr, Laureno R, Lachman T, Victor M: Anticoagulant-induced hemorrhage in acute cerebral embo- lism (abstract). Ann Neurol 1982; 12:75
- [16]16. Fishman RA: Brain edema, in Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds): Stroke: Pathophysiology, Diagnosis, and Management. New York, Churchill Livingstone, Inc, 1986, vol 1, pp 119-126
- Authors
- Maruyama, M., Kuriyama, Y., Sawada, T., Yamaguchi, T., Fujita, T., & Omae, T.
- Affiliations
- National Cerebral and Cardiovascular Center (JP)
- Venue
- Stroke
- Published
- 1989-10
- Volume
- 20
- Issue
- 10
- Pages
- 1305-1310
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W1980555074
- Semantic Scholar
- a5f5de335a0fd7c98ec42acdb9a086942cf0cbee
- Cited by
- 68
- References
- 12
- Citations by year
- 2024: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 8 · 2015: 3 · 2014: 6 · 2013: 3 · 2012: 3
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- cardioembolic stroke, open heart surgery, cerebral embolism, infective endocarditis, prosthetic valve endocarditis, septic embolism, intracardiac thrombus, atrial myxoma, neurological outcome, cerebral hemorrhage, cerebral edema, transient ischemic attack, timing of surgery
- MeSH terms
- Adult, Aged, Intracranial Embolism and Thrombosis, Cerebral Infarction, Female, Heart Diseases, Humans, Male, Middle Aged, Postoperative Complications
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