Brain "embolism" detected by magnetic resonance imaging during percutaneous mitral balloon commissurotomy.
OBJECTIVE
The common finding of thrombi between the bifoil balloons when they were extracted after mitral dilation prompted us to look for evidence of minor brain embolisms using the sensitive technique of BMRI (brain magnetic resonance T2-weighted imaging).


METHODS
BMRI was performed within 48 hr before and after a percutaneous mitral balloon commissurotomy (PMBC) in each of the 63 patients in this study.


RESULTS
There was evidence (hyperintensity foci: HI) of a previous asymptomatic brain embolism in 38 of 63 patients before PMBC and a new HI appeared in 18 of 63 patients after the procedure. New HI signals were found exclusively in the white matter in 8 of 18 patients and in only 3 of 18 were HI signs larger than 1 cm. One patient, with an HI signal > 1 cm in the thalamus and another < 1 cm in the brain stem, presented diplopia accompanied by other minor clinical signs. The differences in HI rate among four subgroups (1, older vs younger than 43 years; 2, sinus rhythm vs atrial fibrillation; 3, echo score < 8 vs > 8; 4, patients from western countries vs the others) were not statistically significant, probably because the number of patients in each subgroup was low. Patients in atrial fibrillation had slightly more (not significant) HI before PMBC (15/20, 75%) than patients in sinus rhythm (23/43, 53%), but after PMBC their HI frequencies were similar (atrial fibrillation: 5/20, 25%; sinus rhythm: 13/43, 30%).


CONCLUSIONS
Brain microembolism is frequent during PMBC, but is often anatomically limited and free from clinical signs in most cases. Brain embolism seems to be related mainly to the procedure itself and not the features of the patient.
Rocha
P
P
Department of Physiology, Hôpital Ambroise Paré, Université René Descartes, Billancourt, France.
Qanadli
S D
SD
Strumza
P
P
Kacher
S
S
Aberkane
L
L
Aubry
P
P
Rigaud
M
M
Lacombe
P
P
Raffestin
B
B
D000328:Adult; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008946:Mitral Valve Stenosis / Q000628:therapy*; D012214:Rheumatic Heart Disease / Q000628:therapy; D013997:Time Factors