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Posted by CCF Neurology MD on January 24, 1998 at 06:15:25:
In Reply to: RE: MEMORY LOSS AFTER OPEN HEART SURGERY posted by THOMAS CZAPLICKI on January 23, 1998 at 12:40:30:
: : I had open heart surgery (mechanical valve replacement) about a year ago, since then I have been having problems with memory loss (short term). I did go to a neurologist and he has discovered micro-emboli traveling to my brain at a rate of 5 or 6 a minute. He did explain that during surgery these micro-emboli develop. My neurologist thinned my blood to see if the amount of micro-emboli would decrease, that did not help now he put me on a baby aspirin a day to break down the platelets. Did not go back yet for test. I was wondering if there are any ongoing studies or test that I could get more information. Also am I in a dangerous situation or is it controllable and should I be going to another specialist.
RE: As you advised prior you said that the doctor was doing a good job. I recently went back complaining about more memory loss problem. He advised me that there was an article in the Journal of Neuroimaging stating that the emboli that he had dicovered were probably gaseous and not to worry about them, I asked is there a way to tell if mine were gaseous or not and he responded his equipment could not detect this. Also he advised to stop taking the baby aspirin. I am very concerned about this and asking you to advise me on what to do my memory problems seem to be worse and my wife cannot understand all of this. If you know of any studies ongoing maybe I could contact them or point me in right direction. Thank you
Your questions are very pertinent and raise issues of intense current interest amongst stroke neurologists, cardiologists, and cardiothoracic surgeons. My thoughts are as under:
1. The memory loss that you suffer, I feel, is unrelated to the microemboli seen by your neurologist. It is likely a consequence of the cardiac surgery that you have had. It has been increasingly recognised for the past several years that the very process of cardiac surgery (cardiopulmonary bypass and other steps) has damaging effects on the brain. Using sensitive neuropsychological methods, it has been shown that the majority of elderly patients undergoing open heart surgery suffer subtle cognitive difficulties for several months post-operatively. The problem, however, improves with time and is reversible in most patients.
2. The transcranial doppler (TCD) that your neurologist used for counting micro-emboli is a relatively recent test that is believed to be predictive of the risk of stroke in high-risk cardio-embolic situations, such as yours. The presence or frequency of microemboli (or HITS) has been shown to correlate with future stroke risk, and it has been felt (but not conclusively proven) that a response of the HITS frequency to treatment (such as coumadin, coumadin and aspirin, or heparin) is predictive of the efficacy of such therapy in peventing stroke.
3. Not all microemboli are clots. Air bubbles can cause similar signals. Methods have been proposed to distinguish clots or platelets from gas, but these are not routinely practised except in academic or research applications in some departments with special expertise in this area.
4. The use of TCD for predicting stroke risk and monitoring therapy in prosthetic valve patients is specially problematic. The are several indicators that appear to imply that the majority of microemboli in this situation are indeed gaseous from
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