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The Journal of Cardiovascular Surgery 1998 October;39(5):613-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Intracranial high-intensity transient signals after homograft or mechanical aortic valve replacement

Lievense A. M. 1, 2, Bakker S. L. M. 2, Dippel D. W. J. 2, Taams M. A. 3, Koudstaal P. J. 2, Bogers A. J. J. C. 1

From the Departments of 1 Cardiothoracic Surgery, 2 Neurology and 3 Cardiology, University Hospital, Rotterdam, The Netherlands


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Objective. Comparison of the occur­rence, inten­sity and ­rate of ­high-inten­sity tran­sient sig­nals (­HITS), meas­ured in ­both mid­dle cere­bral arter­ies by trans­cra­ni­al Doppler ultra­sound (TCD) ­after mechan­i­cal or homo­graft aor­tic ­valve implan­ta­tion.
Experimental ­design. TCD mon­i­tor­ing was per­formed by ­means of a ­pulsed Doppler ultra­sound ­with two 2 MHz ­probes, sta­bi­lized on the ­head and direct­ed at the mid­dle cere­bral ­artery.
Setting. Outdoor ­patients ­after aor­tic ­valve replace­ment in a uni­ver­sity hos­pi­tal.
Patients. The ­study ­cohort com­prised a ran­dom trans­verse sam­ple of ­patients and includ­ed 20 ­patients ­with a mechan­i­cal aor­tic ­valve and 20 ­with a homo­graft aor­tic ­valve. Comparisons ­were ­made ­with 20 admit­ted con­trol ­patients.
Interventions. No inter­ven­tions.
Measures. No sig­nif­i­cant num­ber of ­HITS ­were expect­ed in the homo­graft ­group and a lim­it­ed num­ber in the mechan­i­cal ­valve ­group.
Results. ­HITS ­were detect­ed in ­more ­patients ­after implan­ta­tion of a mechan­i­cal aor­tic ­valve pros­the­sis com­pared ­with a homo­graft aor­tic ­valve (16 ver­sus 8, p=0.02). Nevertheless, ­more ­patients ­with a homo­graft aor­tic ­valve ­showed ­HITS ­than the con­trol ­patients (8 ver­sus 1, p=0.02). The ­mean num­ber of ­HITS in the mechan­i­cal pros­the­sis ­group was high­er ­than in the homo­graft ­group (3, ­range 0-18 ver­sus 13, ­range 0-70, p<0.05). ­HITS in ­patients ­with mechan­i­cal pros­the­ses had a high­er ampli­tude ­than ­HITS in ­patients ­with homo­graft aor­tic ­valves (p<0.0001). Focal neu­ro­log­i­cal def­i­cit (FND) was diag­nosed in 9 ­patients (mechan­i­cal pros­the­sis 6 ver­sus homo­graft 3, ns).
Conclusions. ­HITS com­mon­ly ­occur ­both in ­patients ­with a mechan­i­cal aor­tic ­valve and in ­patients ­with a homo­graft aor­tic ­valve. ­HITS ­occur sig­nif­i­cant­ly ­less ­often, at a low­er ­rate and ­with a low­er inten­sity in ­patients ­with homo­graft aor­tic ­valve com­pared ­with ­patients ­with a mechan­i­cal aor­tic ­valve. Future stud­ies ­should elu­ci­date the ­nature and prog­nos­tic sig­nif­i­cance of ­HITS and ­their rela­tion­ship ­with throm­boem­bol­ic ­events.

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