Reduced Risk of Brain Infarction During a Heart Surgery Using Sonolysis – Pilot Results

Czech version

Authors: E. Hurtíková ¹; M. Roubec ¹; M. Kuliha ^1,2; A. Goldírová ¹; J. Havelka ³; R. Brát ⁴; M. Bortlíček ⁴; R. Herzig ⁵; D. Školoudík ^1,2,6
Authors‘ workplace: Neurologická klinika LF OU a FN Ostrava ¹; Neurologická klinika 1. LF UK a VFN v Praze ²; Ústav radiodiagnostický, LF OU a FN Ostrava ³; Kardiochirurgické centrum, FN Ostrava ⁴; Neurochirurgická a neuroonkologická klinika ÚVN – VFN Praha ⁵; Fakulta zdravotnických věd, UP v Olomouci ⁶
Published in: Cesk Slov Neurol N 2015; 78/111(4): 430-434
Category: Original Paper

Overview

Background:
Heart surgery is burdened with a significant risk of ischemic stroke. Asymptomatic cerebral infarctions can be detected in as many as 32% of patients after heart surgery. The aim of this study is to prove the efficacy of sonolysis (continual transcranial Doppler (TCD) monitoring) during open-heart surgery to decrease the risk of new brain infarctions detected by magnetic resonance imaging (MRI).

Material and methods:
Patients indicated to isolated coronary artery bypass or isolated one heart valve surgery were included in the study. Patients were randomized to a sonolysis group (TCD monitoring), and to a control group without sonolysis. All patients underwent brain MRI before and 24 hours after the surgery and the presence of new ischemic lesions was evaluated.

Results:
During 16 months, 78 patients (48 males, mean age 63.7 ± 15.8 years) were enrolled to the study. Thirty five patients were randomized to the sonolysis group and 43 to the control group. In the sonolysis group, new brain infarctions were found in eight (23%) patients – in the right (TCD-monitored) MCA territory in five patients (14%) but > 0.5 cm³ in two (6%) patients only. In the control group, new infarctions were found in 10 patients (23%) – in the right (TCD-monitored) MCA in eight (19%) patients and > 0.5 cm³ in five (12 %) (p > 0.05 in all cases).

Conclusion:
Pilot study results showed a trend towards reduction in a number and volume of new brain ischemic lesions in patients treated with sonolysis during heart surgery.

Key words:
ultrasound – sonolysis – brain ischemia – coronary artery bypass graft – heart valve – magnetic resonance imaging – brain

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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