title: Neurological and ophthalmological phenomena after aortic conduit surgery.
abstract: Transient neurological and visual signs have been observed in some patients after valved conduit replacement of the aortic valve and ascending aorta. Twenty-seven patients having valved conduit replacement between February 1982 and October 1988 were compared with 21 patients having combined aortic valve replacement (AVR) and ascending aorta (AA) graft replacement. Follow-up in 100% of both groups was obtained for 0.3-6.6 years (mean, 2.6 +/- 0.3 years). Among 20 surviving valved conduit patients, 10 (50.0%) experienced repetitive neurological and visual signs, including scotomata (seven), transient motor ischemic attacks (two), amaurosis fugax (four), and recurring attention lapses suggesting petit mal seizures (one). No patient with AVR + AA graft experienced any events (p = 0.004). All valved conduit and seven (53.8%) of AVR + AA graft patients were on warfarin (p = 0.0016). These events retained the same pattern although they diminished in frequency after 12 months in seven patients (70.0%) and after initiation of dipyridamole in two patients. Rehabilitation was similar in both groups: 18 of 20 (90.0%) valved conduit and 12 of 16 (75.0%) AVR + AA graft patients (p = NS). Transient, repetitive, nonprogressive neurological and ophthalmological phenomena are frequent after valved conduit replacement. The pathophysiological mechanism is unclear, but antiplatelet therapy may provide symptomatic control.
authors.affiliation: Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: P S
authors.initials: PS
authors.lastname: Peigh
authors.forename: V J
authors.initials: VJ
authors.lastname: DiSesa
authors.forename: L H
authors.initials: LH
authors.lastname: Cohn
authors.forename: J J
authors.initials: JJ
authors.lastname: Collins
mesh_terms: D001011:Aorta / Q000601:surgery; D001021:Aortic Valve; D001766:Blindness / Q000209:etiology*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012607:Scotoma / Q000209:etiology*