Embolic foreign material in the central nervous system of pediatric autopsy patients with instrumented heart disease

Matthew Torre, Mirna Lechpammer, Vera Paulson, Sanjay Prabhu, Audrey C. Marshall, Amy L. Juraszek, Robert F. Padera, Elizabeth A. Bundock, Sara O. Vargas, Rebecca D. Folkerth

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)571-577
Number of pages7
JournalJournal of neuropathology and experimental neurology
Volume76
Issue number7
DOIs
StatePublished - 2017

Keywords

  • CNS
  • Cardiovascular interventions
  • Embolization
  • Foreign material

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Neurology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience

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