Resumos
São relatadas as complicações neurológicas assinaladas em 320 pacientes submetidos a cirurgias cardíacas, com uma incidência de 7,8%. As etiologias mais comuns encontradas foram a embolia aérea (4,0%) e isquemia cerebral após hipotensão sistêmica (2,4%). Os autores analisam a patogenia das complicações cerebrais e tentam correlacioná-las com o fluxo sangüíneo cerebral, com o metabolismo cerebral e com a dinâmica dos pequenos vasos cerebrais. Uma revisão a respeito dos métodos para tratamento da isquemia cerebral é apresentada.
The neurological complications following 320 heart surgery, with an incidence of 7,8% are reported. The most common etiology were air embolus (4,0%) and cerebral ischaemia following hypotension (2,4%). The authors analyse the pathogenesis of the cerebral complication and attempt to correlate it with the cerebral blood flow, brain metabolism and dynamics of the small cerebral vessels. A revision about the most common methods of treatment of cerebral ischaemia is made.
Complicações neurológicas da cirurgia cardíaca. Revisão sobre a patogenia e bases para tratamento
Neurological complications of heart surgery. A review about the pathogenesis and treatment bases
Lineu Cesar WerneckI; Danton R. Rocha LouresII
ICentro Neurológico e Serviço de Cirurgia Cardiovascular do Hospital Santa Cruz, Curitiba, Paraná: Auxiliar de Ensino do Departamento de Medicina (Neurologia) da Universidade Federal do Paraná
IICentro Neurológico e Serviço de Cirurgia Cardiovascular do Hospital Santa Cruz, Curitiba, Paraná: Auxiliar de Ensino do Departamento de Cirurgia (Cirurgia Cardiovascular) da Universidade Federal do Paraná
RESUMO
São relatadas as complicações neurológicas assinaladas em 320 pacientes submetidos a cirurgias cardíacas, com uma incidência de 7,8%. As etiologias mais comuns encontradas foram a embolia aérea (4,0%) e isquemia cerebral após hipotensão sistêmica (2,4%). Os autores analisam a patogenia das complicações cerebrais e tentam correlacioná-las com o fluxo sangüíneo cerebral, com o metabolismo cerebral e com a dinâmica dos pequenos vasos cerebrais. Uma revisão a respeito dos métodos para tratamento da isquemia cerebral é apresentada.
SUMMARY
The neurological complications following 320 heart surgery, with an incidence of 7,8% are reported. The most common etiology were air embolus (4,0%) and cerebral ischaemia following hypotension (2,4%). The authors analyse the pathogenesis of the cerebral complication and attempt to correlate it with the cerebral blood flow, brain metabolism and dynamics of the small cerebral vessels. A revision about the most common methods of treatment of cerebral ischaemia is made.
Texto completo disponível apenas em PDF.
Full text available only in PDF format.
Centro Neurológico Hospital Santa Cruz Rua do Rosário 144 80000 Curitiba, PR Brasil.
- 1. ALLARDYCE, D. B.; YOSHIDA, S. H. & ASHMORE, P. G. The importance of microembolism in the pathogenesis of organ dysfunction caused by prolonged use of the pump oxygenator. J. Thoracic & Cardiovas. Surg. 52:706, 1966.
- 2. ARFEL, G.; WEISS, J. & DuBOUCHET, N. EEG findings during open heart surgery with extra-corporeal circulation. In Meyer, J. S. e Gastaut, H. Cerebral Anoxia and the Electroencephalogram, Charles C. Thomas, Springfield (Illinois), 1961.
- 3. BRAWLEY, B. W.; STRANDNESS Jr., E. & KELLY, W. A. The physiologic response to therapy in experimental cerebral ischemia. Arch. Neurol. (Chicago) 17:80, 1967.
- 4. BRENNAN, R. W.; PATTERSON, R. H. & KESSLER, J. Cerebral blood flow and metabolism during cardiopulmonary bypass: evidence of microembolic encephalopathy. Neurology (Minneapolis) 21:665, 1971.
- 5. BRIERLEY, J. B. Systemic hypotension: neurological and neuropathological aspects. In Modern Trends in Neurology. Vol. 5. Appleton-Century-Crofts, London, 1970, pág. 164.
- 6. BROOK, M. Patogenia dos acidentes vasculares cerebrais em função dos conhecimentos atuais sobre circulação regional do encéfalo. Resumo do V Congresso Brasileiro de Neurologia, São Paulo, Julho 1972.
- 7. CARTER, C. C.; EICHLING, J. O.; DAVIS, D. O. & PERPOGOSSIAN, M. M. Correlation of regional cerebral blood flow with regional oxygen uptake using O15 method. Neurology (Minneapolis) 22:755, 1972.
- 8. CLASEN, R. A.; PANDOLFI, S. & HASS, G. M. Interrupted hypothermia in experimental cerebral edema. Neurology (Minneapolis) 20:279, 1970.
- 9. FIESCHI, C.; AGNOLI, A.; BATTISTINI, N.; BOZZAO, L. & PRENCIPE, M. Derangement of regional cerebral blood flow and of its regulatory mechanisms in acute cerebrovascular lesions. Neurology (Minneapolis) 18:1166, 1968.
- 10. FIESCHI, C.; AGNOLI, A.; BATTISTINI, N. & BOZZAO, L. Regional cerebral blood flow in patients with brain infarcts. Arch. Neurol. (Chicago) 15:653, 1966.
- 11. FISCHER, E. G. & AMES, A. Studies on mechanisms of impairment of cerebral circulation following ischemia: effect of hemodilution and perfusion pressure. Stroke 3:538, 1972.
- 12. FIESCHER-WILLIAMS, M.; GOTTSCHALK, P. G. & BROWELL, J. N. Transient cortical blindness. Neurology (Minneapolis) 20:353, 1970.
- 13. GILMAN, S. Cerebral disorders after open-heart operations. New Engl. J. Med. 272:489, 1965.
- 14. GILROY, J.; BARNHART, M. I. & MEYER, J. S. Treatment of acute stroke with dextran 40. J.A.M.A. 210:293, 1969.
- 15. GINSBERG, M. D. & MYERS, R. E. The topography of impaired microvascular perfusion in the primate brain following total circulatory arrest. Neurology (Minneapolis) 22:998, 1972.
- 16. GOTTSTEIN, U. & PAULSON, O. B. The effect of intracarotid aminophyline infusion on the cerebral circulation. Stroke 3:560, 1972.
- 17. HARPER, A. M.; DESHMUK, V. D.; ROWAN, J. O. & JENNETT, B. The influence of sympathetic nervous activity on cerebral blood flow. Arch. Neurol. (Chicago) 27:1, 1972.
- 18. HARRISON, M. J. G. & RUSSELL, R. W. Effect of dexamethasone on experimental cerebral infarction in the gerbil. J. Neurol. Neurosurg. Psychiat. 35:520, 1972.
- 19. HASBROUCK, J. D. & RIGOR, B. M. The oxygen tension of cerebrospinal fluid during cardiopulmonary bypass. J. Thoracic & Cardiovac. Surg. 58:754, 1969.
- 20. HEKMATPANAH, J. Cerebral blood flow dynamics in hypotension and cardiac arrest. Neurology (Minneapolis) 23:174, 1973.
- 21. HOEDT-RASMUSSEN, K.; SKINHOJ, E.; PAULSON, O.; EWALD, J.; BJERRUM, J. K.; FAHRENKRUG, A. & LASSEN, N. A. Regional cerebral blood flow in acute apoplecy (the luxury perfusion syndrome of brain tissue). Arch. Neurol. (Chicago) 17:271, 1967.
- 22. JAFFE, M. E.; McHENRY, L. C. & GOLDBERG, H. I. Regional cerebral blood flow measurement with small probes. Neurology (Minneapolis) 20:225, 1970.
- 23. JAVID, H.; TUFO, H. M.; NAJAFI, H.; DYE, W. S.; HUNTER, J. A. & JULIAN O. C. Neurological abnormalities following open-heart surgery. J. Thoracic & Cardiovasc. Surg. 58:502, 1969.
- 24. KOGURE, K.; FUJISHIMA, M.; SCHEINBERG, P. & REINMUTH, O. M. Effects of changes in carbon dioxide pressure and arterial pressure on blood flow in ischemic regions of the brain in dogs. Circulation Research 24:557, 1969.
- 25. LASSEN, N. A. Cerebral blood flow and oxygen consumption in man. Physiological Reviews 19:183, 1959.
- 26. LASSEN, N. A. The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localised within the brain. Lancet 2:1113, 1966.
- 27. McHENRY Jr., L. C. Cerebral blood flow. New Engl. J. Med. 274:82, 1966.
- 28. McHENRY Jr., L. C. Cerebral vasodilator therapy in stroke. Stroke 3:686, 1972.
- 29. McHENRY, L. C.; GOLBERG, H. I.; JAFFE, M. E.; KENTON III, E. J.; WEST, J. W. & COOPER, E. S. Regional cerebral blood flow. Arch. Neurol. (Chicago) 27:403, 1972.
- 30. McHENRY, L. C.; JEFFE, M. E.; KAWAMURA, J. & GOLBERG, H. I. Effect of papaverine on regional blood flow in focal vascular disease of the brain. New Engl. J. Med. 282:1167, 1970.
- 31. MEYER, J. S.; CHARNEY, J. Z.; RIVERA, V. M. & MATHEW, N. T. Cerebral embolization: prospective clinical analysis of 42 cases. Stroke 2:541, 1971.
- 32. MEYER, J. S.; FUKUUCHI, Y.; SHIMAZU, K.; OHUCHI, T. & ERICSSON, A. D. Abnormal hemispheric blood flow and metabolism in cerebrovascular disease: therapeutic trials with 5% CO2 inhalation, hyperventilation and intravenous infusion of THAM and mannitol Stroke 3:157, 1972.
- 33. MEYER, J. S.; FUKUUCHI, Y.; SHIMAZU, K.; OHUCHI, T. & ERICSSON, A. D. Effect of intravenous infusion of glycerol on hemispheric blood flow and metabolism in patients with acute cerebral infarction. Stroke 3:168, 1972.
- 34. MEYER, J. S.; GOTOH, F.; GILROY, J. & NARA, N. Improvement in brain oxygenation and clinical improvement in patients with strokes treated with papaverine hydrochloride. J.A.M.A. 194:957, 1965.
- 35. MEYER, J. S.; KANDA, T.; FUKUUCHI, Y.; SHIMAZU, K.; DENNIS, E. W. & ERICSSON, A. D. Clinical prognosis correlated with hemispheric blood flow in cerebral infarction. Stroke 2:383. 1971.
- 36. MEYER, J. S.; KANDA, T.; SHINOHARA, Y.; FUKUUCHI, Y.; SHIMAZU, K.; ERICSSON, A. D. & GORDON, W. H. Effect of hexabendine on cerebral hemispheric blood flow and metabolism. Neurology (Minneapolis) 21:691, 1971.
- 37. MEYER, J. S.; SAWADA, T.; KITAMURA, A. & TOYODA, M. Cerebral oxygen, glucose, lactate and pyruvate metabolism in stroke. Therapeutic considerations. Circulation 37:1036, 1968.
- 38. MEYER, J. S.; TERAURA, T.; MARX, P.; HASHI, K.; & SAKAMOTO, K. Brain swelling due to experimental cerebral infarction. Changes in vasomotor capacitance and effects of intravenous glycerol. Brain 95:833, 1972.
- 39. MILLER, J. R. & MYERS, R. E. Neurological effects of systemic circulatory arrest in the monkey. Neurology (Minneapolis) 20:715, 1970.
- 40. MILLER, J. R. & MYERS, R. E. Neuropathology of systemic circulatory arrest in adult monkeys. Neurology (Minneapolis) 22:888, 1972.
- 41. MILLIKAN, C. H. Reassessment of anticoagulant therapy in variou types of occlusive cerebrovascular disease. Stroke 2:201, 1971.
- 42. MILLIKAN, C. H. Summary of the eight Princeton Conference on cerebral vascular diseases (January 5-7, 1972, Nassau Tavern, Princeton, New Jersey). Stroke 3:105, 1972.
- 43. OLESEN, J. Total co2, lactate and pyruvate in brain biopsies taken after freezing the tissue in situ. Acta Neurol. Scandinav. 46:141, 1970.
- 44. OLESEN, J. & PAULSON, O. B. The effect of intra-arterial papaverine on the regional cerebral blood flow in patients with stroke or intracranial tumor. Stroke 2:148, 1971.
- 45. OLESEN, J.; PAULSON, O. B. & LASSEN, N. A. Regional cerebral blood flow in man determined by the initial slope of the clearence of intra-arterially injected 133 Xe. Stroke 2:519, 1971.
- 46. PATTEN, B. M.; MENDELL, J.; BRUUN, B.; CURTIN, W. & CARTER, S. Double-blind study of the effects of dexamethasone on acute stroke. Neurology (Minneapolis) 22:377, 1972.
- 47. PATTERSON, R. H. & KESSLER, J. Microemboli during cardiopulmonary bypass detected by ultrasound. Surg. Gyn. .& Obst. 129:505, 1969.
- 48. PAULSON, G. W.; LOCKE, G. E. & YASHON, D. Cerebral spinal fluid lactic acid following circulatory arrest. Stroke 2:565, 1971.
- 49. PAULSON, O. B. Regional cerebral blood flow in apoplexy due to occlusion of the midle cerebral artery. Neurology (Minneapolis) 20:63, 1970.
- 50. PAULSON, O. B. Cerebral apoplexy (stroke): pathogenesis, pathophysiology and therapy as illustrated by regional blood flow measurements in the brain. Stroke 2:327, 1971.
- 51. POTCHEN, E. J.; DAVIS, D. O.; WHARTON, T.; HILL, R. & TAVERAS, J. M. Regional cerebral blood flow in man: a study of the xenon 133 washout method. Arch. Neurol. (Chicago) 20:378, 1969.
- 52. PROSENZ, P. Investigations on the filter capacity of the dog's brain. Arch. Neurol. (Chicago) 26:479, 1972.
- 53. RACE, D.; DEDICHEN, H. & SCHENK, W. G. Regional blood flow during dextran-induced normovolemic hemodilution in the dog. J. Thoracic & Cardiovasc. Surg. 53:578, 1967.
- 54. RAICHLE, M. E. & PLUM, F. Hyperventilation and cerebral blood flow. Stroke 3:566, 1972.
- 55. REES, J. E.; DUBOULAY. G. H.; BULL, J. W. D.; MARSHALL, J.; RUSSELL, R. W. & SYMON, L. The comparative analysis of isotope clearence curves in normal and ischemie brain. Stroke 2:444, 1971.
- 56. REGLI, F.; YAMAGUCHI, T. & WALTZ, A. G. Effects of acetazolamide on cerebral ischemia and infarction after experimental occlusion of middle cerebral artery. Stroke 2:456, 1971.
- 57. ROSENBLUM, W. I. Neurogenic control of cerebral circulation. Stroke 2:429, 1971.
- 58. SACHDEV, N. S.; CARTER, C. C; SWANK, R. L. & BLACHLY, P. H. Relationship between post-cardiotomy delirium, clinical neurological changes and EEG abnormalities. J. Thoracic & Cardiovasc. Surg. 54:557, 1967.
- 59. SHINOHARA, Y. Mechanism of chemical control of cerebral vasomotor activity. Neurology (Minneapolis) 23:186, 1973.
- 60. SIEGEL, B. A.; STUDER, R. K. & POTCHEN, E. J. Steroid therapy of brain edema. Arch. Neurol. (Chicago) 27:209, 1972.
- 61. SKINHOJ, E. & PAULSON, O. B. The mechanism of action of aminophylline upon cerebral vascular disorders. Acta Neurol. Scandinav. 46:129, 1970.
- 62. SKINHOJ, E. The sympathetic nervous system and the regulation of cerebral blood flow in man. Stroke 3:711, 1972.
- 63. STOCKARD, J. J.; BICKFORD, R. G. & SCHAUBLE, J. F. Pressure-dependent cerebral ischemia during cardiopulmonary bypass. Neurology (Minneapolis) 23: 521, 1973.
- 64. SWANK, R. L.; HIRSCH, H.; BREUER, M. & HISSEN, W. Effect of glass woll filtration on blood during extracorporeal circulation. Surg. Gyn. Obst. 117:547, 1963.
- 65. SYMON, L.; DORSCH, N. W. C. & GANZ, J. C. Lactic acid efflux from ischaemic brain: an experimental study. J. Neurol. Sci. 17:411, 1972.
- 66. TABADDOR, K.; GARDNER, T. J. & WALKER, A. E. Cerebral circulation and metabolism at deep hypothermia. Neurology (Minneapolis) 22:1065, 1972.
- 67. THOMAS, J. E. & AYYAR, R. Systemic fat embolism. Arch. Neurol. (Chicago) 26:517, 1972.
- 68. van LEEUWEN, W. S.; MECHELSE, K..; KOK, L. & ZIERFUSS, E. EEG during heart operation with artificial circulation. In Meyer & Gastaut Cerebral Anoxia and the Electroencephalogram. Charles C. Thomas, Springfield (Illinois), 3961.
- 69. WIEDERHOLT, W. C.; LOCKE, G. & YASHON, D. Hypotension and its effect on EEG activity in the dog. Neurology (Minneapolis) 22:717, 1972.
- 70. WISE, G.; SUTTER, R. & BURKHOLDER, J. The treatment of brain ischemia with vasopressor drugs. Stroke 3:135, 1972.
- 71. WRICHT, G. Ultrastructural changes in dog brains immediately following non-pulsatile extracorporeal circulation and prolonged anaesthesia. Br. J. Exp. Path. 53:501, 1972.
- 72. YAMAGUCHI, T.; REGLI, F. & WALTZ, A. Effect of PaCO2 on hyperemia and ischemia in experimental cerebral infarction. Stroke 2:139, 1971.
- 73. YATSU, F. A.; DIAMOND, I.; GRAZIANO, C. & LINDQUIST, P. Experimental brain ischemia protection from irreversible damage with a rapid-acting barbiturate (Methohexital). Stroke 3:726, 1972.
Datas de Publicação
-
Publicação nesta coleção
15 Abr 2013 -
Data do Fascículo
Dez 1973