Neuropathologische Befunde nach herzchirurgischen Operationen

Abstract

Neuropathological studies may contribute to the discovery of central nervous system complications after heart surgery and thus help to reduce the incidence of postoperative neurological or cognitive disturbances. We examined the brains of 262 such patients operated for coronary bypass, valve replacement, or heart transplantation. Circulatory disturbances (macro- and microhemorrhages, infarcts, subarachnoid hemorrhages, and hypoxemic brain damage) were present in 128 cases (49%), as the cause of death in 33 cases (12.6%). The infarcts were caused by local arteriosclerosis of brain arteries, arterial emboli originating from the operative sites or myocardial infarctions, or by fat emboli, foreign body emboli or megakaryocytic capillary emboli in rare cases. Inflammatory disturbances were present in 17 cases and consisted of fungal or bacterial septicopyemic changes (12) or of glial nodules (5) as the substrate of a viral or autoimmunencephalitis (Bickerstaff). An incidental finding was Alzheimer's disease in 37 cases (14% of the material) of elderly patients, often associated with cerebral amyloid angiopathy but not as cause of death or cause of macroscopic brain hemorrhage. Since we have conducted an autopsy study, there is a limitation to transfer the documented changes to the total group of post-cardiac surgery patients with neurologic and cognitive deficits. Contrary to some previous reports, histologically overt microembolic phenomena do not seem to play a major role in our material. On the other hand, careful scrutiny revealed non-fatal white matter microhemorrhages of varying frequency in the different groups, especially after valve operations. These as well as the occasional glial nodules, after resorption and microscarring, could well be the cause of slight neurologic and cognitive impairments.

Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study

“…Although the EuroSCORE-predicted mortality was higher in the former group (5.9% versus 4.1%, p < 0.001), the observed 30-day mortality was nonsignificantly lower (2.2% versus 2.5%, p = 0.55) and its use was associated with a lower propensity-score adjusted 30-day mortality (RR: 0.67; 95% CI: 0.45–0.98) as compared to the control group. Emboli related death is a common cause for postoperative mortality and may have contributed to this difference [ 28 ]. Another explanation for this difference may be that attending anesthesiologists differed not only in the use of modified TEE but also in other aspects of patient management.…”

Anterior ischemic optic neuropathy after conventional coronary artery bypass graft surgery – a case report

“…Both embolization changes and circulatory disturbances may lead to intraoperative ischemia of multiples tissues, including brain and eye tissues. Emmich et al [26] revealed the presence of infracts due to emboli, macro- and micro-hemorrhages, subarachnoidal hemorrhages and disorders caused by brain tissue ischemia in 49% of patients who died after cardiac surgical procedures.…”

Imaging Techniques for Diagnosis of Thoracic Aortic Atherosclerosis

“…Histopathology of emboli captured with an intra-aortic filter showed that 85% of emboli consisted of fibrous atheroma or cap [ 19 ]. Also, an autopsy study including 262 patients who died after cardiac surgery showed that cerebral circulatory disturbances were present in 49% of the brains, which primarily consisted of (micro) infarction, followed by cerebral and subarachnoidal haemorrhage; however, the incidence of generalized hypoxemia was low (1.9–2.7% if heart transplant was excluded) [ 20 ]. The cause of death was considered to be of primary cerebral aetiology in 12.9% of patients [ 20 ].…”