Ultrasonographic demonstration of manipulation-related aortic injuries after cardiac surgery

Ura, Masashi; Sakata, Ryuzo; Nakayama, Yoshihiro; Gotō, Tomoko

doi:10.1016/s0735-1097(00)00548-9

Cited by 81 publications

(38 citation statements)

References 13 publications

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“…Ura and colleagues demonstrated that stroke might be caused not only by aortic clamping but by jet from the arterial cannula. 4 Based on rheological and pathological observation, orifi ces of arch vessels tend to have dense deposition of atheromatous plaque, which is observed as paste-like material spilling out from the arterial wall during surgery. 20 Sometimes patients have mobile, fragile plaque around the ostium of the BCA.…”

Section: Discussionmentioning

confidence: 99%

“…3 In these conditions, manipulation of the ascending aorta, including cannulation and clamping, may cause deleterious atheroembolism and should be avoided. 4,5 Retrograde perfusion from the femoral artery may induce paradoxical atheroembolism to the brain in patients with iliac artery atherosclerosis, an abdominal aortic aneurysm, and/or a descending aortic aneurysm. Although axillary artery perfusion is one of the solutions for this problem, there are several limitations to this method.…”

Section: Introductionmentioning

confidence: 99%

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Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Minakawa

Fukuda

Inamura

et al. 2008

Gen Thorac Cardiovasc Surg

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Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Minakawa

Fukuda

Inamura

et al. 2008

Gen Thorac Cardiovasc Surg

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“…Evaluation for atherosclerosis of the aorta is not routinely performed preoperatively in children, although atheroembolism from the ascending aorta is a major etiologic factor for stroke in adult patients undergoing cardiac surgery. Cohen et al (6) showed that non calcified plaques are associated with a higher risk of vascular events and surgical manipulation has been reported to cause new mobile lesions in a diseased aorta (7). Soft atheromas are most likely to embolized as a result of manipulation.…”

Section: Discussionmentioning

confidence: 99%

Off-pump coronary bypass in a child with familial hypercholesterolemia: premature atherosclerosis of the ascending aorta

Gülcan

Yıldırım²,

Türköz³

2011

Anadolu Kardiyol Derg

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“…Various studies have identified patientspecific risk factors for stroke associated with CABG as follows: prior stroke or transient ischemic attack [2,13,14], carotid artery stenosis [15][16][17][18], aortic atherosclerosis [19,20], atrial fibrillation [3,21], peripheral arterial disease [21], prior cardiac surgery [22], poor baseline clinical condition [3,23], left ventricular dysfunction [21], prolonged time on cardiopulmonary bypass (CPB) [21,22], conventional onpump CABG [22] and older age [2,3]. The presence of any one risk factor for stroke is not considered a contraindication [13].…”

Section: Risk Factorsmentioning

confidence: 99%

Stroke associated with coronary artery bypass grafting

Arai

2015

Gen Thorac Cardiovasc Surg

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While coronary artery bypass grafting (CABG) has been playing a significant role in the revascularization for ischemic heart disease, neurological complications associated with CABG have been a primary concern. Stroke, although the incidence is low, is one of the most devastating complication of CABG. Many studies have identified the risk factors for stroke with CABG, such as prior stroke, carotid artery stenosis, aortic atherosclerosis, atrial fibrillation and cardiopulmonary bypass. Various rational approaches focusing on individual risk factor have been proposed for the stroke. Prophylactic carotid revascularization is an important strategy, and the diagnosis of carotid stenosis has to be established correctly. Prevention of emboli from aortic plaque is also an essential issue. Intraoperative monitoring with transesophageal or epiaortic ultrasound is useful to identify mobile atheromatous plaques and to select appropriate aortic manipulations. Maintenance of cerebral blood flow and blood pressure during cardiopulmonary bypass might be critical issues. Besides, there are conflicting two opinions regarding off-pump CABG; one supports an efficiency for the prevention of stroke while the other advocates no effect. This discrepancy might be explained by the difference of the risk of stroke in the population of the individual study and by the variation of the percentage of aortic clamping or aortic anastomosis in each study. Pharmaceutical therapies such as statin, preventive medication for atrial fibrillation, or antiplatelet are promising methods. Although it is hard to decrease the incidence of the stroke with any single countermeasure, sustained effort should be continued to overcome the stroke associated with CABG.

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Ultrasonographic demonstration of manipulation-related aortic injuries after cardiac surgery

Cited by 81 publications

References 13 publications

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

Off-pump coronary bypass in a child with familial hypercholesterolemia: premature atherosclerosis of the ascending aorta

Stroke associated with coronary artery bypass grafting

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