Table 1.
Summary of patient details, intra-operative haematocrit, and analysis of TCD recordings.
Fig 1.
Total numbers of bubbles detected in the left and right middle cerebral arteries.
Similar numbers of bubbles were detected in the left and right MCAs of individual patients. Markers are labelled with patient identifiers.
Fig 2.
Estimated distribution of bubble sizes detected during cardiac surgery.
(a) Distribution of bubble sizes estimated based on analysis of the ultrasound backscatter (MEBR values) from 18667 embolic signals. Overall, the median diameter of bubbles was 33 μm (IQR: 18 to 69 μm). Signals observed following removal of the aortic cross-clamp are shaded. (b) Percentage of emboli, bubble volume, and predicted dissolve times for 18 μm, 38 μm, 100 μm, 500 μm and 1 mm diameter air bubbles.
Fig 3.
Timing and diameters of bubbles in a 60 year old patient during Triple CABG.
Markers denote individual embolic events where the y-axis and marker size indicate estimated bubble diameter. The lower panel displays the predicted number of blocked MCA end arterioles estimated by Monte-Carlo simulation. The shaded regions highlight 95% confidence intervals, based on uncertainty in bubble diameter and variations in outcome between simulations. The inset shows a 3D reconstruction of the circle of Willis labelled with estimated total volume of air and MCA diameters.
Fig 4.
Timing and diameters of bubbles in a 76 year old patient during Triple CABG.
Markers denote individual embolic events where the y-axis and marker size indicate estimated bubble diameter. The lower panel displays the predicted number of blocked MCA end arterioles estimated by Monte-Carlo simulation. The shaded regions highlight 95% confidence intervals, based on uncertainty in bubble diameter and variations in outcome between simulations. The inset shows a 3D reconstruction of the circle of Willis labelled with estimated total volume of air and MCA diameters.
Fig 5.
Timing and diameters of bubbles in a 71 year old patient during combined MVR and CABG.
Markers denote individual embolic events where the y-axis and marker size indicates estimated bubble diameter. The lower panel displays the predicted number of blocked end arterioles obtained by Monte-Carlo simulation. The shaded regions highlight 95% confidence intervals, based on uncertainty in bubble diameter and variations in outcome between simulations. The inset shows a 3D reconstruction of the circle of Willis labelled with estimated total volume of air and MCA diameters.
Fig 6.
Timing and diameters of bubbles in a 55 year old patient during combined AVR and CABG.
Markers denote individual embolic events where the y-axis and marker size indicates estimated bubble diameter. The lower panel displays the predicted number of blocked end arterioles obtained by Monte-Carlo simulation. The shaded regions highlight 95% confidence intervals, based on uncertainty in bubble diameter and variations in outcome between simulations. The inset shows a 3D reconstruction of the circle of Willis labelled with estimated total volume of air and MCA diameters.