Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: relation to neurocognitive function
Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: relation to neurocognitive function
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DOI：
10.1016/j.ejcts.2005.02.043
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发表时间：
2005-07-01
影响因子：
3.4
通讯作者：
Jakob, H
中科院分区：
文献类型：
--
作者：
Knipp, SC;Matatko, N;Jakob, H
目的：冠状动脉旁路移植术后，一些使用磁共振成像（MRI）的研究表明，在没有明显神经功能缺损的患者中出现了新的小的缺血性脑病变。我们的目的是前瞻性地评估使用MRI心脏瓣膜置换术后的脑损伤，并确定与神经认知功能的关系。研究方法：研究了30例接受心脏瓣膜置换术（主动脉瓣置换术[AVR]，n = 24;二尖瓣置换术[MVR]，n = 2; AVR和MVR，n = 2; AVR和二尖瓣修复术，n = 2）的患者，平均年龄为64.9 ± 9.8岁（范围：32-82岁，12例女性）。研究方案包括神经系统检查、综合神经心理学评估和弥散加权（DW）MRI。分别在术前、术后5天和4个月进行检查。结果：术后DW MRI发现14例患者（47%）新发脑局灶性病变。无患者显示局灶性神经功能缺损。6例患者（43%）有多处（>= 3处）病变（范围，1-7处）。病变体积范围为50-500 mm（3），除1例1900 mm（3）的局部梗死外。在总共41处病变中，27处（66%）位于右半球，32处位于皮质下位置。到术后5天，在影响记忆、注意力和信息处理速率的13项测试中，有5项观察到显著的神经认知下降。到4个月时，所有认知领域的功能障碍都已恢复。新的缺血性病变的存在与出院时神经认知功能下降无关。临床和手术变量与新发DW病变或神经精神病结局之间也无显著相关性。结论：心脏瓣膜置换术后，通过弥散加权MRI检测到新的小缺血性脑病变。术后早期出现神经认知功能下降，但在4个月内消退。未发现新的缺血性病变与术后认知功能障碍或临床变量的相关性。（c）2005年Elsevier B. V.保留所有权利。
Objective: Following coronary artery bypass graft surgery, some studies using magnetic resonance imaging (MRI) have demonstrated new small ischemic brain lesions in patients without apparent neurological deficits. We aimed to prospectively evaluate brain injury after cardiac valve replacement using MRI and to determine the relationship to neurocognitive function. Methods: Thirty patients with a mean age of 64.9 +/- 9.8 years (range, 32-82, 12 female) receiving cardiac valve replacement (aortic valve replacement [AVR], n = 24; mitral valve replacement [MVR], n 2; AVR and MVR, n=2; AVR and mitral valve repair, n=2) were investigated. Study protocol included neurological examination, comprehensive neuropsychological assessment and diffusion-weighted (DW) MRI. The investigations were performed before surgery and 5 days and 4 months after surgery. Results: Postoperative DW MRI detected new focal brain lesions in 14 patients (47%). No patient revealed a focal neurological deficit. Six patients (43%) had multiple (>= 3) lesions (range, 1-7). Lesion volume ranged from 50-500 mm(3) except 1 territorial infarct of 1900 mm(3). Of a total of 41 lesions, 27 (66%) were located in the right hemisphere and 32 in a subcortical location. By 5 days postoperatively, significant neurocognitive decline was observed in 5 of 13 tests affecting memory, attention and rate of information processing. By 4 months, dysfunction had recovered in all cognitive areas. The presence of new ischemic lesions was not associated with neurocognitive decline at discharge. There was also no significant correlation between clinical and operative variables and the presence of new DW lesions or neuropsychotogicat outcome. Conclusions: Following cardiac valve replacement, new small ischemic brain lesions were detected by diffusion-weighted MRI. Neurocognitive decline was present early after operation, but resolved within 4 months. A correlation of new ischemic lesions to postoperative cognitive dysfunction or clinical variables was not found. (c) 2005 Elsevier B.V. All rights reserved.