Embolic Foreign Material in the Central Nervous System of Pediatric Autopsy Patients With Instrumented Heart Disease.

Autor:	Torre M; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Lechpammer M; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Paulson V; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Prabhu S; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Marshall AC; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Juraszek AL; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Padera RF; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Bundock EA; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Vargas SO; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts., Folkerth RD; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology; and Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Journal of neuropathology and experimental neurology [J Neuropathol Exp Neurol] 2017 Jul 01; Vol. 76 (7), pp. 571-577.
DOI:	10.1093/jnen/nlx037
Abstrakt:	Upon detection of foreign-body embolization to the central nervous system (CNS) following a specific invasive cardiovascular procedure in 1 autopsied child, we undertook a quality assurance analysis to determine whether other patients had had similar events. Autopsies of all infants and children with history of cardiac catheterization, heart surgery on cardiopulmonary bypass, and/or extracorporeal membrane oxygenation over a 5-year period at a single tertiary care institution were reviewed for light-microscopic evidence of foreign material. Of the 24 patients meeting clinical criteria (13 females, 11 males; ages 6 days to 20 years, median age 7.5 months), 8 (33%) had foreign embolic material to the CNS. The material was associated with a cellular inflammatory reaction in all cases, with a subset associated with infarcts. No embolic foreign material was detected in 14 age-matched patients without history of cardiovascular procedures. Particles acquired from ex vivo manipulation of a catheter type utilized in at least 1 of the affected patients demonstrated similar histologic characteristics. We conclude that, in addition to recognized risks of hypoxic-ischemic brain damage in congenital cardiopulmonary disease, potential brain insult exists in the form of instrumentation-related foreign emboli to the cerebral vasculature. Cardiac catheters are a potential source of foreign embolic material. (© 2017 American Association of Neuropathologists, Inc. All rights reserved.)
Databáze:	MEDLINE
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