(Stroke. 1997;28:322-325.)
© 1997 American Heart Association, Inc.
Articles |
Clinically Silent Microemboli in Patients With Artificial Prosthetic Aortic Valves Are Predominantly Gaseous and Not Solid
the Neurologische Klinik der Medizinischen Klinik zu Luebeck (M.K., I.K., D.W.D.); Hyperbares Zentrum Norddeutschland am Friedrich-Ebert-Krankenhaus, Neumuenster (J.H., M.W., K.T.); and Klinik und Poliklinik fur Neurologie, Westfaelische Wilhelms-Universitaet Muenster (D.W.D.) (Germany).
Correspondence to Prof Dr med M. Kaps, Neurologische Klinik der Medizinischen Klinik zu Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany.
Background and Purpose Microembolic signals (MES) are frequently observed by transcranial Doppler ultrasound after prosthetic heart valve implantation. Whether these MES are due to solid or gaseous particles is uncertain. We hypothesized that MES are gaseous and that if they are due to cavitation effects, their occurrence should respond to changes of dissolved oxygen concentration in the blood.
Methods Transcranial monitoring of MES was performed in five patients with prosthetic aortic valves, who inspired 100% oxygen through a facial mask. In one patient 100% oxygen was administered under hyperbaric (2.5 kPa) conditions in a hyperbaric chamber.
Results Inspiration of 100% oxygen reduced the total number of MES from 96/30 min to 2/30 min. Increasing the concentration of dissolved oxygen in the hyperbaric chamber led to an increase from 0.3 MES per minute (1.0 kPa) to 0.9 MES per minute (2.5 kPa).
Conclusions The dependence of occurrence of MES in patients with prosthetic cardiac valves on the oxygen partial pressure in blood provides strong evidence that these microemboli are gaseous.
Key Words: embolism • heart valve prosthesis • transcranial Doppler • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  R. A. Rodriguez, H. J. Nathan, M. Ruel, F. Rubens, D. Dafoe, and T. Mesana A method to distinguish between gaseous and solid cerebral emboli in patients with prosthetic heart valves Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 89 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Guerrieri Wolf, B. P. Choudhary, Y. Abu-Omar, and D. P. Taggart Solid and gaseous cerebral microembolization after biologic and mechanical aortic valve replacement: Investigation with multirange and multifrequency transcranial Doppler ultrasound J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 512 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Dittrich and E. B. Ringelstein Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures Stroke, February 1, 2008; 39(2): 503 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. H. Thoennissen, M. Schneider, A. Allroggen, M. Ritter, R. Dittrich, C. Schmid, H. H. Scheld, E. B. Ringelstein, and D. G. Nabavi High level of cerebral microembolization in patients supported with the DeBakey left ventricular assist device J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1159 - 1166. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Barak and Y. Katz Microbubbles: Pathophysiology and Clinical Implications Chest, October 1, 2005; 128(4): 2918 - 2932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A Rodriguez, K. A Williams, A. Babaev, F. Rubens, and H. J Nathan Effect of perfusionist technique on cerebral embolization during cardiopulmonary bypass Perfusion, January 1, 2005; 20(1): 3 - 10. [Abstract] [PDF]
|
|
|
|
|
|
S. Milo, E. Rambod, C. Gutfinger, and M. Gharib Mitral mechanical heart valves: in vitro studies of their closure, vortex and microbubble formation with possible medical implications Eur. J. Cardiothorac. Surg., September 1, 2003; 24(3): 364 - 370. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Nabavi, J. Stockmann, C. Schmid, M. Schneider, D. Hammel, H. H. Scheld, and E. B. Ringelstein Doppler microembolic load predicts risk of thromboembolic complications in Novacor patients J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 160 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Russell and R. Brucher Online Automatic Discrimination Between Solid and Gaseous Cerebral Microemboli With the First Multifrequency Transcranial Doppler Stroke, August 1, 2002; 33(8): 1975 - 1980. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Droste, K. Kuhne, R. M. Schaefer, and E. B. Ringelstein Detection of microemboli in the subclavian vein of patients undergoing haemodialysis and haemodiafiltration using pulsed Doppler ultrasound Nephrol. Dial. Transplant., March 1, 2002; 17(3): 462 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Baumgartner, A. Frick, C. Kremer, E. Oechslin, E. Russi, J. Turina, and D. Georgiadis Microembolic signal counts increase during hyperbaric exposure in patients with prosthetic heart valves J. Thorac. Cardiovasc. Surg., December 1, 2001; 122(6): 1142 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Markus Monitoring Embolism in Real Time Circulation, August 22, 2000; 102(8): 826 - 828. [Full Text] [PDF]
|
|
|
|
|
|
D.J. Wheatley, L. Raco, G.M. Bernacca, I. Sim, P.R. Belcher, and J.S. Boyd Polyurethane: material for the next generation of heart valve prostheses? Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 440 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kleine, M. Perthel, J. M. Hasenkam, H. Nygaard, S. B. Hansen, and J. Laas Downstream turbulence and high intensity transient signals (HITS) following aortic valve replacement with Medtronic Hall or St. Jude Medical valve substitutes Eur. J. Cardiothorac. Surg., January 1, 2000; 17(1): 20 - 24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Wilhelm, J. Ristich, L. E. Knepper, R. Holubkov, S. R. Wisniewski, R. L. Kormos, and W. R. Wagner Measurement of Hemostatic Indexes in Conjunction With Transcranial Doppler Sonography in Patients With Ventricular Assist Devices Stroke, December 1, 1999; 30(12): 2554 - 2561. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Kemeny, D. W. Droste, S. Hermes, D. G. Nabavi, G. Schulte-Altedorneburg, M. Siebler, and E. B. Ringelstein Automatic Embolus Detection by a Neural Network Stroke, April 1, 1999; 30(4): 807 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Goertler, M. Baeumer, R. Kross, T. Blaser, G. Lutze, S. Jost, and C.-W. Wallesch Rapid Decline of Cerebral Microemboli of Arterial Origin After Intravenous Acetylsalicylic Acid Stroke, January 1, 1999; 30(1): 66 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gencbay, F. Turan, M. Degertekin, B. Yaymaci, and I. Dindar Contrast Echoes Detected During Percutaneous Mitral Balloon Commissurotomy with Inoue Balloons and Their Relation to Cerebral Microembolic Signals Angiology, November 1, 1998; 49(11): 909 - 914. [Abstract] [PDF]
|
|
|
|
|
|
L. Valton, V. Larrue, A. P. le Traon, P. Massabuau, and G. Geraud Microembolic Signals and Risk of Early Recurrence in Patients With Stroke or Transient Ischemic Attack Stroke, October 1, 1998; 29(10): 2125 - 2128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Geiser, M. Sturzenegger, U. Genewein, A. Haeberli, and J. H. Beer Mechanisms of Cerebrovascular Events as Assessed by Procoagulant Activity, Cerebral Microemboli, and Platelet Microparticles in Patients With Prosthetic Heart Valves Stroke, September 1, 1998; 29(9): 1770 - 1777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bot, E.F. Bruggemans, B.J. Delemarre, G.L. van Rijk-Zwikker, A. van der Kleij, M. Kaps, J. Hansen, M. Weiher, K. Tiffert, and D. Droste Microembolic Signals Under Increased Ambient Pressure • Response Stroke, May 1, 1998; 29(5): 1069 - 1070. [Full Text]
|
|
|
|
|
|
D. Georgiadis, R. W. Baumgartner, R. Karatschai, A. Lindner, and H. R. Zerkowski Further evidence of gaseous embolic material in patients with artificial heart valves J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 808 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jacobs, M. Neveling, M. Horst, M. Ghaemi, J. Kessler, H. Eichstaedt, J. Rudolf, P. Model, H. Bonner, E. R. de Vivie, et al. Alterations of Neuropsychological Function and Cerebral Glucose Metabolism After Cardiac Surgery Are Not Related Only to Intraoperative Microembolic Events Stroke, March 1, 1998; 29(3): 660 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bernd Ringelstein, D. W. Droste, V. L. Babikian, D. H. Evans, D. G. Grosset, M. Kaps, H. S. Markus, D. Russell, and M. Siebler Consensus on Microembolus Detection by TCD Stroke, March 1, 1998; 29(3): 725 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, T. Hansberg, V. Kemeny, D. Hammel, G. Schulte-Altedorneburg, D. G. Nabavi, M. Kaps, H. H. Scheld, and E. B. Ringelstein Oxygen Inhalation Can Differentiate Gaseous From Nongaseous Microemboli Detected by Transcranial Doppler Ultrasound Stroke, December 1, 1997; 28(12): 2453 - 2456. [Abstract] [Full Text]
|
|
|
|
|
|
D. Georgiadis, A. Wenzel, D. Lehmann, A. Lindner, H.R. Zerkowski, S. Zierz, and M.P. Spencer Influence of Oxygen Ventilation on Doppler Microemboli Signals in Patients With Artificial Heart Valves Stroke, November 1, 1997; 28(11): 2189 - 2194. [Abstract] [Full Text]
|
|
|
|
|
|
V. L. Babikian, C. A. C. Wijman, C. Hyde, N. L. Cantelmo, M. R. Winter, E. Baker, and V. Pochay Cerebral Microembolism and Early Recurrent Cerebral or Retinal Ischemic Events Stroke, July 1, 1997; 28(7): 1314 - 1318. [Abstract] [Full Text]
|
|
|
|
|
|
D. Georgiadis, M. Preiss, A. Lindner, Y. Gybels, S. Zierz, and H. R. Zerkowski Doppler Microembolic Signals in Children With Prosthetic Cardiac Valves Stroke, July 1, 1997; 28(7): 1328 - 1329. [Abstract] [Full Text]
|
|