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J Thorac Cardiovasc Surg 2001;121:1101-1116
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Doppler microembolic signals in patients with two different types of bileaflet valves

From the Department of Neurology^a and the Department of Cardiothoracic Surgery,^b Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany, and the Department of Cardiac Surgery, Royal Infirmary, University of Glasgow,^c Glasgow, United Kingdom.

Received for publication May 26, 2000. Revisions requested June 26, 2000;.revisions received Aug 24, 2000. Accepted for publication Nov 28, 2000. Address for reprints: D. Georgiadis, MD, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 110, 691210 Heidelberg, Germany (E-mail: dimitrios.georgiadis{at}medizin.uni-halle.de).

Objectives: This study was performed to evaluate the prevalence and counts of Doppler microembolic signals in patients with St Jude Medical valves (St Jude Medical, Inc, St Paul, Minn) and patients with ATS valves (ATS Medical, Inc, Minneapolis, Minn) and their relation to clinical parameters.
Methods: A total of 179 outpatients of the department of cardiothoracic surgery were examined. They included 98 men and 81 women, aged 61 ± 11 years, with ATS (n = 91) or St Jude Medical (n = 88) valves in the aortic (n = 110), mitral (n = 39), or both positions (n = 30). Neurologic examination was followed by transcranial Doppler monitoring for microembolic signals. Monitoring was performed bilaterally over the middle cerebral arteries for 1 hour per session.
Results: Microembolic signal counts and prevalence were significantly higher in patients with St Jude Medical as compared with ATS valves. Valve type and presence of diabetes mellitus were the only predictors of microembolic signal prevalence on multivariate analysis. No influence of microembolic signals on cerebral embolic complications was established. Additionally, patients with a postoperative history of cerebral embolic complications did not have a higher number of microembolic signals than remaining patients. Interobserver variability was satisfactory.
Conclusions: Patients with St Jude Medical valves were shown to have significantly higher microembolic signal counts than patients with ATS valves. However, our results suggest that microembolic signal counts cannot be used to predict cerebral embolic complications. Their relation to neuropsychologic deficits remains to be evaluated.

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