Blood-brain barrier disruption after cardiac surgery.
OBJECTIVE
CNS complications are often seen after heart surgery, and postsurgical disruption of the BBB may play an etiologic role. The objective of this study was to determine the prevalence of MR imaging-detected BBB disruption (HARM) and DWI lesions after cardiac surgery.


METHODS
All patients had an MRI after cardiac surgery. For half the patients (group 1), we administered gadolinium 24 hours after surgery and obtained high-resolution DWI and FLAIR images 24-48 hours later. We administered gadolinium to the other half (group 2) at the time of the postoperative scan, 2-4 days after surgery. Two stroke neurologists evaluated the images.


RESULTS
Of the 19 patients we studied, none had clinical evidence of a stroke or delirium at the time of the gadolinium administration or the scan, but 9 patients (47%) had HARM (67% in group 1; 30% in group 2; P = .18) and 14 patients (74%) had DWI lesions (70% in group 1; 78% in group 2; P = 1.0). Not all patients with DWI lesions had HARM, and not all patients with HARM had DWI lesions (P = .56).


CONCLUSIONS
Almost half the patients undergoing cardiac surgery have evidence of HARM, and three-quarters have acute lesions on DWI after surgery. BBB disruption is more prevalent in the first 24 hours after surgery. These findings suggest that MR imaging can be used as an imaging biomarker to assess therapies that may protect the BBB in patients undergoing heart surgery.
Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA. merinoj@ninds.nih.gov
J G
JG
Merino
L L
LL
Latour
A
A
Tso
K Y
KY
Lee
D W
DW
Kang
L A
LA
Davis
R M
RM
Lazar
K A
KA
Horvath
P J
PJ
Corso
S
S
Warach
D000368:Aged; D001812:Blood-Brain Barrier / Q000473:pathology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology* / Q000473:pathology*; D016896:Treatment Outcome