From Lille University Hospital (G.D., J.-L.L., C.G.) and Charles De
Gaulle University (M.R.), Lille, France.
Correspondence to Dr G. Deklunder, EFCV, Hôpital Cardiologique, CHU de Lille, av du Pr. Leclerc, F-59037 Lille Cédex, France. E-mail gdeklunder{at}chru-lille.fr
Background and Purpose—It has
been shown previously that cerebral microemboli may occur frequently in
patients with a normal mechanical heart valve (MHV) without prior
history of stroke. Some arguments strongly suggest that these
microemboli have a gaseous origin. In other circumstances such as
extracorporeal circulation or decompression in divers, it has been
demonstrated that cerebral microbubbles could lead to some
deterioration in cognitive functions. Therefore, we have studied
attention and memory, which are among the most impaired cognitive
functions as demonstrated in previous studies, in patients with an
MHV.
Methods—Three groups of 12 volunteers each were composed of
patients with an MHV and embolic signals in the cerebral circulation
(group 1), patients with biological prostheses (group 2), and healthy
subjects (group 3). Groups were carefully matched for age and verbal
intellectual abilities. For each group, a transcranial
Doppler examination was performed and a set of cognitive tests
assessing sustained and selective attention and episodic and working
memory was administered.
Results—The mean embolic rate was 29 per hour in patients with an
MHV. No embolus was detected in the other 2 groups. Episodic memory was
significantly modified in both groups 1 and 2 compared with the control
group for tasks that required high-processing resources. Working memory
performance was significantly decreased in MHV patients. No
between-groups differences were observed for the other
parameters.
Conclusions—Alteration of episodic memory can be attributed to a
long-term effect of the surgical procedure. Deterioration of working
memory can be related to the presence of cerebral microemboli in MHV
patients.
© 1998 American Heart Association, Inc.
Original Contributions
Microemboli in Cerebral Circulation and Alteration of Cognitive Abilities in Patients With Mechanical Prosthetic Heart Valves
Key Words: heart-valve prosthesis • HITS • cognitive abilities • transcranial Doppler
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