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J Thorac Cardiovasc Surg 2001;122:1142-1146
© 2001 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Department of Neurologya and the Divisions of Cardiologyb and Pneumology,c Department of Internal Medicine, University of Zurich, Switzerland, and the Department of Neurology,d University of Heidelberg, Germany.
Received for publication March 1, 2001. Revisions requested March 28, 2001; revisions received May 7, 2001. Accepted for publication May 17, 2001. Address for reprints: Ralf W. Baumgartner, MD, Department of Neurology, University Hospital, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland (E-mail: ralf.baumgart ner{at}nos.usz.ch).
Abstract
Background: Patients with prosthetic heart valves have an increased risk of thromboembolic events, and transcranial Doppler sonography reveals microembolic signals. Whereas microembolic signals were initially assumed to be of particulate matter, recent studies suggest that they are partially gaseous in origin. If this is true, alteration of environmental pressure should change microembolic signal counts. We undertook this study to evaluate the influence of hyperbaric exposure on microembolic signal counts in persons with prosthetic heart valves.
Methods and Results: Microembolic signal counts were monitored by transcranial Doppler sonography of both middle cerebral arteries under normobaria (normobaria 1), 2 subsequent periods of hyperbaria (2.5 and 1.75 bar), and a second period of normobaria (normobaria 2) in 15 patients with prosthetic heart valves. Each monitoring period lasted 30 minutes. Compression and decompression rates were 0.1 bar/min. Microembolic signal counts increased from 20 (12-78) at normobaria 1 to 79 (30-165) at 2.5 bar (P < .01 vs normobaria 1 and 2), decreased to 44 (18-128) at 1.75 bar (P < .01 vs normobaria 1 and 2.5 bar; P < .001 vs normobaria 2), and returned to 20 (8-96) at normobaria 2 (values are medians and 95% confidence intervals).
Conclusions: Our results strongly suggest that gaseous bubbles are underlying material for part of the microembolic signals detected in patients with prosthetic heart valves.
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