Torre Matthew, Lechpammer Mirna, Paulson Vera, Prabhu Sanjay, Marshall Audrey C, Juraszek Amy L, Padera Robert F, Bundock Elizabeth A, Vargas Sara O, Folkerth Rebecca D
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.
J Neuropathol Exp Neurol. 2017 Jul 1;76(7):571-577. doi: 10.1093/jnen/nlx037.
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.
在 1 例接受尸检的儿童在特定侵入性心血管手术后发生中枢神经系统（CNS）异物栓塞后，我们进行了质量保证分析，以确定其他患者是否也发生过类似事件。回顾了一家三级医疗机构 5 年内所有有心脏导管插入术、体外循环心脏手术和/或体外膜肺氧合病史的婴儿和儿童的尸检，以寻找异物的光学显微镜证据。在符合临床标准的 24 例患者中（13 例女性，11 例男性；年龄 6 天至 20 岁，中位年龄 7.5 个月），8 例（33%）出现了中枢神经系统异物栓塞。所有病例中，该物质均伴有细胞炎症反应，部分病例伴有梗死。在 14 例无心血管手术史的年龄匹配患者中未检测到栓塞性异物。从至少 1 例受影响患者使用的导管类型的体外操作中获取的颗粒显示出相似的组织学特征。我们得出结论，除了先天性心肺疾病中公认的缺氧缺血性脑损伤风险外，还存在器械相关的脑动脉血管异物栓塞形式的潜在脑损伤。心脏导管是异物栓塞物质的潜在来源。
