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Eur J Cardiothorac Surg 2005;28:88-96
© 2005 Elsevier Science NL

Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: relation to neurocognitive function

^a Department of Thoracic and Cardiovascular Surgery, West German Heart Centre, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany
^b Department of Neurology, University Hospital Essen, Essen, Germany
^c Institute of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany

Received 6 October 2004; received in revised form 23 February 2005; accepted 24 February 2005.

^* Corresponding author. Tel.: +49 201 723 4901; fax: +49 201 723 5451. (Email: stephan.knipp{at}uni-essen.de).

Objective: Following coronary artery bypass graft surgery, some studies using magnetic resonance imaging (MRI) have demonstrated new small ischemic brain lesions in patients without apparent neurological deficits. We aimed to prospectively evaluate brain injury after cardiac valve replacement using MRI and to determine the relationship to neurocognitive function. Methods: Thirty patients with a mean age of 64.9±9.8 years (range, 32–82, 12 female) receiving cardiac valve replacement (aortic valve replacement [AVR], n=24; mitral valve replacement [MVR], n=2; AVR and MVR, n=2; AVR and mitral valve repair, n=2) were investigated. Study protocol included neurological examination, comprehensive neuropsychological assessment and diffusion-weighted (DW) MRI. The investigations were performed before surgery and 5 days and 4 months after surgery. Results: Postoperative DW MRI detected new focal brain lesions in 14 patients (47%). No patient revealed a focal neurological deficit. Six patients (43%) had multiple (3) lesions (range, 1–7). Lesion volume ranged from 50–500mm³ except 1 territorial infarct of 1900mm³. Of a total of 41 lesions, 27 (66%) were located in the right hemisphere and 32 in a subcortical location. By 5 days postoperatively, significant neurocognitive decline was observed in 5 of 13 tests affecting memory, attention and rate of information processing. By 4 months, dysfunction had recovered in all cognitive areas. The presence of new ischemic lesions was not associated with neurocognitive decline at discharge. There was also no significant correlation between clinical and operative variables and the presence of new DW lesions or neuropsychological outcome. Conclusions: Following cardiac valve replacement, new small ischemic brain lesions were detected by diffusion-weighted MRI. Neurocognitive decline was present early after operation, but resolved within 4 months. A correlation of new ischemic lesions to postoperative cognitive dysfunction or clinical variables was not found.

Key Words: Cardiac valve replacement • Magnetic resonance imaging • Neurocognitive function • Diffusion-weighted sequences

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