Embolic Foreign Material in the Central Nervous System of Pediatric Autopsy Patients With Instrumented Heart Disease
| Autor: | Rebecca D. Folkerth, Matthew Torre, Amy L. Juraszek, Mirna Lechpammer, Sanjay P. Prabhu, Vera A. Paulson, Audrey C. Marshall, Robert F. Padera, Sara O. Vargas, Elizabeth A. Bundock |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Heart disease medicine.medical_treatment 030204 cardiovascular system & hematology Pathology and Forensic Medicine law.invention 03 medical and health sciences Cellular and Molecular Neuroscience 0302 clinical medicine law medicine Extracorporeal membrane oxygenation Cardiopulmonary bypass Embolization Cardiopulmonary disease Cardiac catheterization business.industry General Medicine medicine.disease Surgery Catheter Neurology Embolism Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neuropathology & Experimental Neurology. 76:571-577 |
| ISSN: | 1554-6578 0022-3069 |
| DOI: | 10.1093/jnen/nlx037 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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