title: Subclinical embolism in patients undergoing cardiac valve implantation and coronary artery bypass surgery.
abstract: Patients undergoing prosthetic valve insertion and coronary artery bypass surgery were examined with transcranial Doppler ultrasound, recently shown to be capable of detecting continuing subclinical emboli in patients with embolic sources. In 30 patients examined at least 1 year after valve surgery, and in whom warfarinisation was stable within defined limits, 20 of 24 patients (83%) with mechanical valves and 3 of 6 patients (50%) with porcine valves had embolic signals. In a serial preoperative and postoperative study in a further 30 patients, of whom 29 had native or bioprosthetic valves, only the one patient with a previous mechanical mitral valve prosthesis had embolic signals preoperatively. The incidence of embolic signals increased to 9 (30%) on the first postoperative day, and 20 (67%) on day 5. In a similar serial study in 25 patients undergoing coronary bypass surgery, 8 (32%) had preoperative embolic signals, which were explicable by cardiac and/or carotid disease in 6 cases. The embolus signal incidence and count did not increase postoperatively in this group. No embolic signals were found in 15 volunteer controls. The results indicate that prosthetic valves cause continuing microembolisation, detectable by transcranial Doppler; coronary artery bypass cases may have incidental embolic signals which are unaffected by cardiac surgery. This new application of Doppler ultrasound may improve the clinical assessment of embolic risk of new prosthetic valve types and deserves further examination.
authors.affiliation: University Department of Medicine, Western Infirmary, Glasgow, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Grosset
authors.forename: D
authors.initials: D
authors.lastname: Georgiadis
authors.forename: S
authors.initials: S
authors.lastname: Stirling
authors.forename: P
authors.initials: P
authors.lastname: Cowburn
authors.forename: A W
authors.initials: AW
authors.lastname: Kelman
authors.forename: A
authors.initials: A
authors.lastname: Faichney
authors.forename: K R
authors.initials: KR
authors.lastname: Lees
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D001705:Bioprosthesis; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011474:Prosthesis Design; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery; D017585:Ultrasonography, Doppler, Transcranial