Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/36406
Full metadata record
DC FieldValueLanguage
dc.contributor.authorChung, Emma Ming Lin-
dc.contributor.authorBanahan, Caroline-
dc.contributor.authorPatel, Nikil-
dc.contributor.authorJanus, Justyna-
dc.contributor.authorMarshall, David-
dc.contributor.authorHorsfield, Mark A.-
dc.contributor.authorRousseau, Clément-
dc.contributor.authorKeelan, J.-
dc.contributor.authorEvans, David H.-
dc.contributor.authorHague, J. P.-
dc.date.accessioned2016-01-26T14:59:46Z-
dc.date.available2016-01-26T14:59:46Z-
dc.date.issued2015-04-02-
dc.identifier.citationPLoS One, 2015, 10 (4), e0122166en
dc.identifier.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122166en
dc.identifier.urihttp://hdl.handle.net/2381/36406-
dc.description.abstractBACKGROUND: Thousands of air bubbles enter the cerebral circulation during cardiac surgery, but whether high numbers of bubbles explain post-operative cognitive decline is currently controversial. This study estimates the size distribution of air bubbles and volume of air entering the cerebral arteries intra-operatively based on analysis of transcranial Doppler ultrasound data. METHODS: Transcranial Doppler ultrasound recordings from ten patients undergoing heart surgery were analysed for the presence of embolic signals. The backscattered intensity of each embolic signal was modelled based on ultrasound scattering theory to provide an estimate of bubble diameter. The impact of showers of bubbles on cerebral blood-flow was then investigated using patient-specific Monte-Carlo simulations to model the accumulation and clearance of bubbles within a model vasculature. RESULTS: Analysis of Doppler ultrasound recordings revealed a minimum of 371 and maximum of 6476 bubbles entering the middle cerebral artery territories during surgery. This was estimated to correspond to a total volume of air ranging between 0.003 and 0.12 mL. Based on analysis of a total of 18667 embolic signals, the median diameter of bubbles entering the cerebral arteries was 33 μm (IQR: 18 to 69 μm). Although bubble diameters ranged from ~5 μm to 3.5 mm, the majority (85%) were less than 100 μm. Numerous small bubbles detected during cardiopulmonary bypass were estimated by Monte-Carlo simulation to be benign. However, during weaning from bypass, showers containing large macro-bubbles were observed, which were estimated to transiently affect up to 2.2% of arterioles. CONCLUSIONS: Detailed analysis of Doppler ultrasound data can be used to provide an estimate of bubble diameter, total volume of air, and the likely impact of embolic showers on cerebral blood flow. Although bubbles are alarmingly numerous during surgery, our simulations suggest that the majority of bubbles are too small to be harmful.en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
dc.relation.urihttp://www.ncbi.nlm.nih.gov/pubmed/25837519-
dc.rightsCopyright © 2015 Chung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are crediteden
dc.subjectBubblesen
dc.subjectEmbolectomyen
dc.subjectCardiac surgeryen
dc.subjectCardiopulmonary bypassen
dc.subjectSurgical and invasive medical proceduresen
dc.subjectAcoustic signalsen
dc.subjectArteriolesen
dc.subjectCerebral arteriesen
dc.titleSize distribution of air bubbles entering the brain during cardiac surgeryen
dc.typeJournal Articleen
dc.identifier.doi10.1371/journal.pone.0122166-
dc.identifier.eissn1932-6203-
dc.identifier.piiPONE-D-14-19923-
dc.description.statusPeer-revieweden
dc.description.versionPublisher Versionen
dc.type.subtypeJournal Article;Research Support, Non-U.S. Gov't-
pubs.organisational-group/Organisationen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGYen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicineen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular Sciencesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themesen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/Themes/Cardiovascularen
dc.dateaccepted2015-02-08-
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

Files in This Item:
File Description SizeFormat 
Size distribution of air bubbles entering the brain during cardiac surgery..pdfPublished (publisher PDF)1.42 MBAdobe PDFView/Open


Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.