Review article : Gaseous microemboli: a review

Henriksen L. , Hjelms E. , Lindeburgh T. Brain hyperperfusion during cardiac operations . J Thorac Cardiovasc Surg 1983; 86: 202-208.

Matsumoto T. , Wolferth CC Jr , Perlman MH Effects of pulsatile and non-pulsatile perfusion upon cerebral and conjunctival microcirculation in dogs. Ann Surg 1981; 37: 61-64.

Sanderson JM , Wright G. , Sims FW Brain damage in dogs immediately following pulsatile and non-pulsatile blood flows in extracorporeal circulation. Thorax 1972; 27: 275-86.

Branthwaite MA Cerebral blood flow and metabolism during open-heart surgery. Thorax 1974; 29: 633-38.

Stockard JJ , Bickford RG , Myers RR et al . Hypotension induced changes in cerebral function during cardiac surgiery. Stroke 1974; 5: 730-46.

DeWall R. What constitutes adequate perfusion ? J Cardiovasc Surg 1975; 16: 458-64.

Ng WS , Rosen M. Carbon dioxide in the prevention of air embolism during open-heart surgery . Thorax 1968; 23: 194-96.

Prough DS , Stump DA , Roy RA , Gravlee GP et al . Response of cerebral blood flow to changes in carbon dioxide tension during hypothermic cardiopulmonary bypass. Anesthesiology 1986; 64: 576-81.

Taylor KM , Devlin BJ , Mittra SM , Gillan JG , Brannan JJ , McKenna JM Assessment of cerebral damage during open-heart surgery. A new experimental model. Scand J Thorac Cardiovasc Surg 1980 ; 14: 197-203.

Aberg T. , Ronquist G. , Tyden H. , Ahlund P. , Bergstrom K. Release of adenylate kinase into cerebrospinal fluid during open-heart surgery and its relation to postoperative intellectual function. Lancet 1982; 1 (2): 1139-42.

Shaw PJ The incidence and nature of neurological morbidity following cardiac surgery: a review. Perfusion 1989; 4: 83-91.

Hallenbeck JM , Furlow TW , Rvei TA , Greenbaum LJ Extracorporeal glass-wool filtration of whole blood enhances post-ischemic recovery of the cortical sensory evoked response . Stroke 1979; 10: 158-64.

Ehrenhaft JL , Claman MA , Layton JM , Zimmerman GR Cerebral complications of open-heart surgery: further observations. J Thorac Cardiovasc Surg 1961; 42 : 514-26.

Von Schroder W. Uber die Bildungsstalle des Harnstoff Arch Exp Path Pharmacol 1882; 15: 364-402.

Clark JrLC , Gollan F. , Gupta VB The oxygenation of blood by gas dispersion. Science 1950; 111 : 85-87.

Kessler J. , Patterson RH Jr. The production of microemboli by various blood oxygenators. Ann Thorac Surg 1970; 9 : 221-28.

Patterson RH Jr , Kessler J. Microemboli during cardiopulmonary bypass detected by ultrasound. Surg Gynecol Obstet 1969; 129: 505-10.

Reed CC , Miller D. , Stafford TB , McInnis RJ Microemboli emission of extracorporeal oxygenators. Les Cahiers de CECEC 1984; 22 : 35-40.

Clowes Gha Jr , Neville WE , Hopkins A. , Anzola J. , Simeone FA Factors contributing to success or failure in the use of a pump oxygenator for complete bypass of the heart and lung, experimental and clinical. Surgery 1954; 36: 557-79.

Jordan P. Jr , Tolstedt GE , Beretta FF Microbubble formation in artificial oxygenation . Surgery 1957; 43: 266-69.

Tepper R. , Gelman S. , Lowenfels AB , Lord JW Jr. A method for the detection of microbubbles resulting from passage of blood through heart-lung machines. Surg Forum 1958; 9: 171-74.

Hammond GL , Bowley WW Bubble mechanics and oxygen transfer. J Thorac Cardiovasc Surg 1976; 71 : 422-28.

Selman MW , McAlpine WA , Ratan RS The effectiveness of various heart-lung machines in the elimination of microbubbles from the circulation. J Thorac Cardiovasc Surg 1967; 53: 613-17.

Simmons E. , MaGuire C. , Lichti E. , Helvey W. , Almond C. A comparison of the microparticles produced when two disposable-bag oxygenators and a disc oxygenator are used for cardiopulmonary bypass. J Thorac Cardiovasc Surg 1972; 63: 613-21.

Krebber HJ , Hanrath P. , Janzen R. , Ritoff M. , Rodewald G. Gas emboli during open-heart surgery. Thorac Cardiovasc Surgeon 1982; 30 : 401-404.

Krebber HJ , Hill JD , Osborn JJ , Iatrides A. Microemboli during extracorporeal circulation. Thorac Cardiovasc Surg 1980; 28 : 249-52.

Krebber HJ , Lutz G. , Polonius M-J. , Rodewald G. Microembolization due to microbubbles released from the oxygenator . In: Becker et al. eds, Psychopathological and neurological dysfunctions following open-heart surgery, Berlin: Springer Verlag, 1982: 352-61.

Pearson DT , Holden MP , Poslad SJ Gaseous microemboli production of bubble and membrane oxygenators . In: Lautier A, Gille JP eds, Extracorporeal gas exchange. Design and techniques. London: Saunders, 1986: 198-234.

Pearson DT , McArdle B. , Poslad SJ , Murray A. A clinical evaluation of the performance characteristics of one membrane and five bubble oxygenators: gas transfer and gaseous microemboli production . Perfusion 1986; 1: 15-26.

Pearson DT , Poslad SJ , Murray A. , Clayton R. Extracorporeal circulation material evaluation: microemboli. Life Support Syst 1987; 5 : 53-67.

Pearson DT , Holden MP , Polsad SJ , Murray A. , Waterhouse PS A clinical evaluation of the gas transfer characteristics and gaseous microemboli production of two bubble oxygenators. Life Support Syst 1984; 2 : 252-66.

Hicks RE , Edmunds LH Jr. Microembolus production and blood filtration during extracorporeal perfusion . In: Zapol WM, Qvist J eds, Artificial lungs for acute respiratory failure, Washington DC: Hemisphere, 1976: 157-67.

Kaplan JA Cardiopulmonary bypass. In: Kaplan JA ed. Cardiac Anesthesia . New York: Grune and Stratton, 1979.

Hill AG , Groom RC , Tewksbury L. et al . Sources of gaseous microemboli during cardiopulmonary bypass. Proc Am Acad Cardiovasc Perf 1988; 9: 122-30.

Edmunds LH Jr , Williams W. Microemboli and the use of filters during cardiopulmonary bypass. In: Utley JR ed, Pathophysiology and techniques of cardiopulmonary bypass, Volume 2, Baltimore: Williams and Wilkins, 1983: 101-14.

Brennan RW , Patterson RH , Kessler J. Cerebral blood flow and metabolism during cardiopulmonary bypass . Neurology 1971; 21: 665-72.

Pearson DT , Clayton R. , Murray A. , McArdle B. Blood gas control in bubble and membrane oxygenators. Proc Am Acad Cardiovasc Perf 1987; 8: 190-99.

Rusmin S. , Rapp RP Bivins BA , DeLuca PP Conditions permitting air flow through an air-venting inline filter . Am J Hosp Pharm 1979; 36 : 749-53.

Allardyce DB , Yoshida SH , Ashmore PG The importance of microembolism in the pathogenesis of organ dysfunction caused by prolonged use of the pump oxygenator. J Thorac Cardiovasc Surg 1966; 52: 706-15.

Butler BD Gaseous micro emboli: concepts and considerations. JECT 1983; 15: 148-55.

Landew M. , Bowles LT , Gelman S. , Lowenfels AB , Tepper R. , Lord JW Effects of intra-arterial microbubbles. Am J Physiol 1960; 199: 485-90.

Pearson DT , Holden MP , Waterhouse PS , Clarke I. Gaseous microemboli during open-heart surgery: detection and prevention . Proc Am Acad Cardiovasc Perf 1983 ; 4: 103-09.

Pearson DT Microemboli: gaseous and particulate. In: Taylor KM ed, Cardiopulmonary bypass. Principles and management . London: Chapman and Hall, 1986: 314-53.

Loop FD , Szabo J. , Rowlinson RD , Urbanek K. Events related to microembolism during open-heart surgery: effectiveness of in-line filtration recorded by ultrasound. Ann Thorac Surg 1976; 21: 412-20.

Mollison DR , Streczyn MV In depth evaluation of arterial line filtration of air emboli in bubbler and membrane oxygenators. JECT 1976; 4: 99-112.

Slaugh RJ A comparison of the defoaming capabilities of four bubble oxygenators . Am SECT Proc 1978; 6 : 97-106.

Clark RE , Dietz DR , Miller JG Continuous detection of microemboli during cardiopulmonary bypass in animals and man. Circulation 1976 ; 54: 74-78.

Pearson DT Blood gas control during cardiopulmonary bypass. Perfusion 1988; 3 : 113-33.

Kurusz M. Gaseous microemboli: sources, causes, and clinical considerations . Med Instrum 1985; 19 : 73-76.

Ferguson TB , Burbank A. , Burford TH The disposable bubble oxygenator. Evaluation of an improved model . Surgery 1967; 61: 260-64.

Kurusz M. , Butler BD Oxygenator performance influence on clinical decisions. Perfusion 1986; 1 : 213-14.

Matthews AJ , Stead AL , Abbott TR Acid base control during hypothermia. Anaesthesia 1984; 39: 649-54.

Weathersby PK , Homer LD Solubility of inert gases in biological fluids and tissues: a review. Undersea Biomed Res 1980; 7: 277-96.

Katoh S. , Yoshida F. Physical factors affecting microembolus formation in extracorporeal circulation . Ann Biomed Eng 1976; 4: 60-67.

Carlson RG , Lande AJ , Landis B. The Lande-Edwards membrane oxygenator during heart surgery, oxygen transfer, microemboli counts and Bender-Gestalt visual motor test scores . J Thorac Cardiovasc Surg 1973; 66: 894-905.

Clark RE Microemboli: an overview. Med Instrum 1985; 19: 53-54.

Graves DJ , Quinn JA , Smock RA Supersaturation and bubble formation in membrane oxygenators. ACEMB Proceedings of 27th Annual Meeting 1974: 197.

Severinghaus JW Temperature gradients during hypothermia . Ann NY Acad Sci 1959; 80: 515-21.

Donald DE , Fellows JL Relation of temperature, gas tension, and hydrostatic pressure to the formation of gas bubbles in extracorporeally oxygenated blood. Surg Forum 1959; 10 : 589-92.

Pollard HS , Fleischaker RJ , Timmes JJ , Karlson KE Blood-brain barrier studies in extracorporeal cooling and warming . J Thorac Cardiovasc Surg 1961; 42: 772-78.

Gibbon JH Maintenance of cardiorespiratory functions by extracorporeal circulation . Circulation 1959; 19: 646-56.

Gollan F. Physiology of deep hypothermia by total body perfusion. Ann NY Acad Sci 1959; 80 : 301-14.

Urschel HC , Greenberg JJ , Roth EJ Rapid hypothermia: an improved extracorporeal method. J Thorac Cardiovasc Surg 1960; 39: 318-29.

Kaplan S. , Clark LC , Fox RP , Daoud G. , Shemtob A. Oxygen embolization during deep hypothermia. Arch Surg 1962; 84 : 122-29.

Almond CH , Jones JC , Snyder HM , Grant SM , Meyer BW Cooling gradients and brain damage with deep hypothermia. J Thorac Cardiovasc Surg 1964; 48: 890-905.

Ehrenhaft JL , Claman MA Cerebral complications of open-heart surgery . J Thorac Cardiovasc Surg 1961; 41: 503-508.

Bjork VO , Hultguist G. : Contraindications to profound hypothermia in open-heart surgery . J Thorac Cardiovasc Surg 1962; 44: 1-13.

Bass RM , Longmore DB Cerebral damage during open-heart surgery. Nature 1969; 222: 30-33.

Hannemann RE , Barile RG Bubble formation in the roller infusion pump . Am J Dis Child 1973 ; 125: 706-08.

Ross J. Jr. Factors influencing the formation of bubbles in blood . Trans Am Soc Artif Intern Organs 1959; 5: 140-47.

Baird RJ , Miyagishima RT The danger of air embolism through pressure-perfusion cannula. J Thorac Cardiovasc Surg 1963; 46: 212-19.

Kort A. , Kronzon I. Microbubble formation: in vitro and in vivo observation. J Clin Ultrasound 1982; 10: 117-20.

Mandl JP Comparison of emboli production between a constrained force vortex pump and a roller pump. Am SECT Proc 1977 ; 5: 27-31.

Kuntz RA , Maurer WG An examination of cavitation as it relates to the extracorporeal arterial infusion model. JECT 1982 ; 14: 345-54.

Solis RT , Goldfinger D. , Gibbs MB , Zeller JA Physical characteristics of microaggregates in stored blood. Transfusion 1974; 14 : 538-49.

Solis RT , Noon GP , Beall AC , DeBakey ME Particulate microembolism during cardiac operation. Ann Thorac Surg 1974; 17 : 332-44.

Solis RT , Kennedy PS , Beall AC , Noon GP , DeBakey ME Cardiopulmonary bypass- microembolization and platelet aggregation . Circulation 1975; 52: 103-108.

Pearson D. , Watson BG , Waterhouse PS An ultrasonic analysis of the comparative efficiency of various cardiotomy reservoirs and blood filters. Thorax 1978; 33: 352-58.

Miller DR , Allbritton FF 'Coronary suction' as a source of air embolism: an experimental study using the Kay-Cross oxygenator. Ann Surg 1960; 151: 75-84.

Wright G. , Sanderson JM Cellular aggregation and trauma in cardiotomy suction systems. Thorax 1979; 34: 621-28.

Gallagher EG , Pearson DT Ultrasonic identification of sources of gaseous microemboli during open-heart surgery. Thorax 1973; 28: 295-305.

Pearson DT Cardiotomy reservoirs and blood filters. In: Ionescu MI ed, Techniques in extracorporeal circulation, second edition, London: Butterworth, 1981.

Pearson DT , Carter RF , Hammo MB , Waterhouse PS Gaseous microemboli during open-heart surgery. In: Longmore DB ed, Towards safer cardiac surgery, Lancaster: MTP, 1981: 325-54.

Carrel A. : Experimental operations on the orifices of the heart. Ann Surg 1914; 60 : 1-6.

Chang C. , Dughi J. , Shitabata P. , Johnson G. , Cool M. , McNamara JJ Air embolism and the radial arterial line. Crit Care Med 1988; 16 : 141-43.

Chan KS , Yang W. Survey of literature related to the problems of gas embolism in human body . J Biomechanics 1969; 2: 299-312.

Airola VM Postoperative venous air embolism. Anesth Analg 1980; 59: 297-98.

Lucas CE , Irani F. Air embolus via subclavian catheter. N Engl J Med 1969; 281: 966-67.

Flanagan JP , Gradisar IA , Gross RJ , Kelly TR Air embolus - a lethal complication of subclavian venipuncture. N Engl J Med 1969; 281: 488-89.

Peters JL , Armstrong R. Air embolism occurring as a complication of central venous catheterization . Ann Surg 1978; 187: 375-78.

Pierce EC Cerebral gas embolism (arterial) with special reference to iatrogenic accidents . HBO Review 1980; 1: 161-88.

Nicks R. Arterial air embolism. Thorax 1967 ; 22: 320-26.

Nicks R. Air embolism in cardiac surgery: incidence and prophylaxis. Aust NZ J Surg 1969; 38 : 328-32.

Utley JR , Stephens DB Prevention of major perioperative neurological dysfunction - a personal perspective. Perfusion 1986; 1: 135-42.

Utley JR , Stephens DB Air embolus during cardiopulmonary bypass. In: Utley JR ed, Pathophysiology and techniques of cardiopulmonary bypass , Volume 2, Baltimore: Williams and Wilkins, 1983: 78-100.

Diehl JT , Ramos D. , Dougherty F. , Pandian NG , Payne DD , Cleveland RJ Intraoperative, two-dimensional echocardiography-guided removal of retained intracardiac air. Ann Thorac Surg 1987; 43: 674-75.

Spencer FC , Rossi NP , Yu S. , Koepke JA The significance of air embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1965; 49: 615-34.

Spencer MP , Lawrence GH , Thomas GI , Sauvage LR The use of ultrasonics in the determination of arterial aeroembolism during open-heart surgiery. Ann Thorac Surg 1969; 8: 489-97.

Starr A. The mechanism and prevention of air embolism during correction of congenital cleft mitral valve. J Thorac Cardiovasc Surg 1960; 39: 808-14.

Taber RE , Maraan BM , Tomatis L. Prevention of air embolism during open heart surgery. A study of the role of trapped air in the left ventricle. Surgery 1970; 68: 685-91.

Kantrowitz A. , Haller JD Cage device for preventing air embolism during open mitral valve surgery. Am J Surg 1969; 118: 476-77.

Eguchi S. , Bosher LH Jr. Myocardial dysfunction resulting from coronary air embolism. Surgery 1962; 51: 103-11.

Geoghegan T. , Lam CR The mechanism of death from intracardiac air and its reversibility. Ann Surg 1953; 138: 351-59.

Durant TM , Oppenheimer MJ , Webster MR , Long J. Arterial air embolism. Am Heart J 1949; 38: 481-500.

Fries CC , Levowitz B. , Adler S. , Cook AW , Karlson KE , Dennis C. Experimental cerebral gas embolism. Ann Surg 1957; 145: 461-70.

Benjamin RB , Turbak CE , Lewis FJ The effects of air embolism in the systemic circulation and its prevention during open cardiac surgery. J Thorac Surg 1957; 34: 548-52.

Utley JR , Stephens DB Venting during cardiopulmonary bypass. In: Utley JR ed, Pathophysiology and techniques of cardiopulmonary bypass , Volume 2, Baltimore: Williams and Wilkins, 1983: 115-27.

Miller BJ , Gibbon JH , Greco VF , Cohn CH , Allbritten FF The use of a vent for the left ventricle as a means of avoiding air embolism to the systemic circulation during open cardiotomy with maintenance of the cardiorespiratory function of animals by a pump oxygenator. Surg Forum 1953; 4 : 29-33.

Janke WH , Esfahani AA Air embolism following open heart surgery. Mich Med 1970;69: 761-62.

Groves LK , Effler DB A needle-vent safeguard against systemic air embolus in open-heart surgery . J Thorac Cardiovasc Surg 1964; 47: 349-54.

Jones RD , Cross FS A vent valve to minimize air embolism during open-heart surgery . J Thorac Cardiovasc Surg 1964; 48: 310-13.

Marco JD , Barner HB Aortic venting comparison of vent effectiveness. J Thorac Cardiovasc Surg 1977; 73 : 287-92.

Nichols HT , Morse DP , Hirose T. Coronary and other embolism during open cardiac surgery. Surgery 1958; 43: 236-44.

Burbank A. , Ferguson TB , Burford TH Carbon dioxide flooding of the chest in open heart surgery. J Thorac Cardiovasc Surg 1965; 50: 691-98.

Shang W. , Rosen M. Carbon dioxide in the prevention of air embolism during open-heart surgery . Thorax 1968; 23: 194-96.

Myerly WH , Throckmorton TD , Gustafson JE The closure of cardiac septal defects. Arch Surg 1957; 74: 918-28.

Ogawa S. , Kai T. , Seno Y., et al . Study of controlled hypothermic selective cardiac cooling. J Jap Surg Soc 1962; 63 : 873.

Eguchi S. , Sakurai Y. , Yamaguchi A. The use of CO2 gas to prevent air embolism during open heart surgery. Acta Microbiol (Niigata) 1963 ; 11: 1.

Stoney WS , Alford WC , Burrus GR , Glassford DM , Thomas CS Air embolism and other accidents using pump oxygenators. Ann Thorac Surg 1980; 29 : 336-40.

Mills NL , Ochsner JL Massive air embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1980; 80: 708-17.

Kurusz M. , Conti VR , Arens JF , Brown JP , Faulkner SC , Manning JR Perfusion accident survey. Proc Am Acad Cardiovasc Perf 1986; 7: 57-64.

Kurusz M. , Conti VR Cerebral protection during cardiopulmonary bypass: devices and techniques to prevent air embolism. In: Willner A, Rodewald C eds, Impact of cardiac surgery on the quality of life: neurological and psychological aspects, New York: Plenum; in press.

Hill AG , Groom RC , Vinansky RP , Speir AM , Macmanus Q. , Lefrak EA Gaseous microemboli and extracorporeal circulation. Proc Am Acad Cardiovasc Perf 1986; 7: 131-37.

Padula RT , Eisenstat TE , Bronstein MU , Camishion RC Intracardiac air following cardiotomy. J Thorac Cardiovasc Surg 1971; 62 : 736-42.

Solis RT , Gibbs MB Filtration of microaggregates in stored blood. Transfusion 1972; 12 : 245-50.

Grulke DC , Marsh NR , Hills BA Measurement of microbubbles using the Coulter counter. Br J Exp Pathol 1973; 54 : 684-91.

Sakauye L. , Servas FM , O'Connor KB , Cottonaro C. An in vitro method to quantitate gaseous microemboli production of bubble oxygenators . JECT 1982; 14: 445-52.

Yost G. The bubble oxygenator as a source of gaseous microemboli. Med Instrum 1985; 19 : 67-69.

Pall DP Development of filters for 400°F and 600°F aircraft hydraulic systems . Wright Air Development Center WADC Tech Rep 1956: 56-249.

Carman PC Flow of gases through porous media. New York: Academic Press, 1956.

Dutton RC , Edmunds LH Jr , Hutchinson JC , Roe BB Platelet aggregate emboli produced in patients during cardiopulmonary bypass with membrane and bubble oxygenators and blood filters. J Thorac Cardiovasc Surg 1974; 67: 258-65.

Edmonds-Seal J. , Maroon JC Air embolism diagnosed with ultrasound . Anaesthesia 1969; 24 : 438-40.

Abts LR , Beyer RT , Galletti PM et al . Computerized discrimination of microemboli in extracorporeal circuits. Am J Surg 1978; 135: 535-38.

Austen WG , Howry DH Ultrasound as a method to detect bubbles or particulate matter in the arterial line during cardiopulmonary bypass. J Surg Res 1965; 5: 283-84.

Pedersen T. , Hatteland K. , Semb Bkh. Bubble extraction by various arterial filters measured in vitro with doppler ultrasound techniques . Ultrasound Med Biol 1982; 8: 71-81.

Pedersen TH , Karlsen HM , Semb G. , Hatteland K. Comparison of bubble release from various types of oxygenators. Scand J Thorac Cardiovasc Surg 1987; 21: 73-80.

Massimino RM , Dyer RK , Martin J. Jr , Gough JD , Starns G. , Karlson KE Microemboli in the arterial line and the carotid artery during perfusion with a bubble oxygenator. ASAIO J 1984; 7: 155-59.

Hatteland K. , Erikson M. A heterodyne ultrasound blood velocity meter . Med Biol Eng Comp 1981; 19: 91-96.

Hatteland K. , Pedersen T. , Semb Bkh. Comparison of bubble release from various types of oxygenators. Scand J Thorac Cardiovasc Surg 1985; 19 : 125-30.

Medwin H. Counting bubbles acoustically: a review. Ultrasonics 1977; 15: 7-13.

Lubbers J. , van den Berg JW An ultrasonic detector for microgas-emboli in a blood flow line. Ultrasound Med Biol 1976; 2: 301-10.

Patterson RH Jr , Kessler J. , Brennan RW , Twichell JB Ultrasonic detection of microemboli from artificial surfaces: evidence of microembolic tissue damage. Bull NY Acad Med 1972; 48 : 452-58.

Manley DM Ultrasonic detection of gas bubbles in blood. Ultrasonics 1969; 7 : 102-105.

Nishi RY Ultrasonic detection of bubbles with doppler flow transducers. Ultrasonics 1972; 173-79.

Semb Bkh , Pedersen T. , Hatteland K. , Storstein L. , Lilleaasen P. Doppler ultrasound estimation of bubble removal by various arterial line filters during extracorporeal circulation. Scand J Thorac Cardiovasc Surg 1982; 16 : 55-62.

Spencer MP , Oyama Y. Pulmonary capacity for dissipation of venous gas emboli. Aerospace Med 1971; 42: 822-27.

Hollon CF , Maginn RR Detection of carotid air emboli. Surg Forum 1969; 20: 182-83.

Moulinier H. , Masurel G. Detection of bubbles in blood vessels and the evaluation of their flow. Med Biol Eng Comput 1978; 16 : 585-88.

Butler BD , Hills BA The lung as a filter for microbubbles. J Appl Physiol 1979; 47 : 537-43.

Butler BD , Hills BA Effect of excessive oxygen upon the capability of the lungs to filter gas emboli. In: Bachrach AJ, Matzen MM eds, Underwater physiology VII, Washington : Undersea Medical Society, 1981 : 95-102.

Nishi RY , Livingstone SD Intravascular changes associated with hyperbaric decompression: theoretical considerations with ultrasound. Aerospace Med 1973; 44: 179-83.

Rubbisow GJ , Mackay RS Decompression study and control using ultrasonics . Aerospace Med 1974; 45: 476-78.

Avecilla LS The physics and instrumentation of diagnostic ultrasound: a review, Part 1. Med Ultrasound 1979; 3: 11-15.

Furness A. , Wright G. Microbubble detection during cardiopulmonary bypass for open-heart surgery. Life Support Syst 1985; 3: 103-109.

Furness A. , Wright G. , Sanderson JM Detection of bubbles in blood vessels and extracorporeal circuits . Med Biol Eng Comput 1979; 17: 534-35.

Richardson PD Qualitative and quantitative methods for investigating gas emboli in blood. Med Instrum 1985 ; 19: 55-58.

Hatteland K. , Semb Bkh. Gas bubble detection in fluid lines by means of pulsed doppler ultrasound . Scand J Thorac Cardiovasc Surg 1985 ; 19: 119-23.

Hickling R. Analysis of echoes from a solid elastic sphere in water. J Acoust Soc Am 1962; 34: 1582-92.

Wright G. , Furness A. , Haigh S. Integral pulse frequency modulated ultrasound for the detection and quantification of gas microbubbles in flowing blood. Perfusion 1987; 2 : 131-38.

Oka Y. , Inoue T. , Hong Y. , Sisto DA , Strom JA Frater Rwm. Retained intracardiac air. Transesophageal echocardiography for definition of incidence and monitoring removal by improved techniques. J Thorac Cardiovasc Surg 1986; 91: 329-38.

Duff HJ , Buda AJ , Kramer R. , Strauss HD , David TE , Berman ND Detection of entrapped intracardiac air with intraoperative echocardiography . Am J Cardiol 1980; 46: 255-60.

Fukuya H. , Suzuki T. , Okumura F. , Kishi Y. , Vefuji T. Detection of air embolism by transesophageal echocardiography. Anesthesiology 1983; 58 : 124-29.

Zhou JL , Chen XF , Zhang QP Detection and removal of intracardiac residual air during open heart surgery with CPB under the guidance of echocardiography. Acta Acad Med Wuhan 1984; 4 : 56-60.

Wright G. , Furness A. Gaseous microembolism - validity of bubble counting systems. Perfusion 1986; 1 : 217-19.

Butler BD Production of microbubbles for use as echo contrast agents. J Clin Ultrasound 1986; 14: 408-12.

Horton JW , Wells CH Resonance ultrasonic measurements of microscopic gas bubbles. Aviat Space Environ Med 1976; 47: 777-81.

Butler BD Biophysical aspects of gas bubbles in blood. Med Instrum 1985; 19 : 59-62.

Gottlieb JD , Ericsson JA , Sweet RB Venous air embolism. A review. Anesth Analg 1965; 44 : 773-79.

Kunkler A. , King H. Comparison of air, oxygen and carbon dioxide embolization. Ann Surg 1959; 149: 95-99.

Harkins HN , Harmon PH Embolism by air and oxygen, comparative studies . Proc Soc Exp Biol NY 1934 ; 32: 178-81.

Yang WJ , Echigo R. , Wotton DR , Hwang JB Experimental studies of the dissolution of gas bubbles in whole blood and plasma- I. Stationary bubbles. J Biomech 1971; 4: 275-81.

Yang WJ , Echigo R. , Wotton DR , Hwang JB Experimental studies of the dissolution of gas bubbles in whole blood and plasma- II. Moving bubbles or liquids. J Biomech 1971; 4: 283-88.

Hlastala MP , van Liew HD Absorption of in vivo inert gas bubbles. Respir Physiol 1975; 24 : 147-58.

Ward CA , Tikuisis P. , Venter RD Stability of bubbles in a closed volume of liquid-gas solution. J Appl Physiol 1975; 24 : 147-58.

Feinstein SB , Shah PM , Bing RJ et al. Microbubble dynamics visualized in the intact capillary circulation. J Am Coll Cardiol 1984; 4: 595-600.

Liebermann L. Air bubbles in water. J Appl Physics 1957; 28 : 205-11.

Tanasawa I. , Wotton DR , Yang W. , Clark DW Experimental study of air bubbles in a simulated cardiopulmonary bypass system with flow constriction . J Biomech 1970; 3 : 417-24.

Epstein PS , Plesset MS On the stability of gas bubbles in liquid-gas solutions. J Chem Physics 1950; 18: 1505-1509.

Turner WR Microbubble persistence in fresh water. J Acoustical Soc Amer 1961; 33 : 1223-33.

Hlastala MP , Farhi LE Absorption of gas bubbles in flowing blood . J Appl Physiol 1973; 35: 311-16.

Adamson AW Physical chemistry of surfaces, second edition. New York: Interscience Publishers, 1967: 523-35.

Munson ES , Merrick HC Effect of nitrous oxide on venous air embolism. Anesthesiology 1966; 27 : 783-87.

Bethune DW Organ damage after openheart surgery. Lancet 1976; 2 : 1410-11.

Tisovec L. , Hamilton WK Newer considerations in air embolism during operation. JAMA 1967; 201: 376.

Philp RB , Inwood MJ , Warren BA Interactions between gas bubbles and components of the blood: implications in decompression sickness. Aerospace Med 1972; 43: 946-53.

Richardson HF , Coles BC , Hall GE Experimental gas embolism: I. Intravenous air embolism. Can Med Assoc J 1937 ; 36: 584-88.

Hartveit F. , Lystad H. , Minken A. The pathology of venous air embolism. Br J Exp Path 1968; 49 : 81-86.

Barnard Eep , Weathersby PK Blood cell changes in asymptomatic divers . Undersea Biomed Res 1981; 8: 187-98.

Bove AA , Hallenbeck JM , Elliott DH Changes in blood and plasma volumes in dogs during decompression sickness. Aerosp Med 1974; 45: 49-55.

Philp RB A review of blood changes associated with compression-decompression: relationship to decompression sickness. Undersea Biomed Res 1974; 1: 117-50.

Philp RB , Bennett PB , Andersen JC et al . Effects of aspirin and dipyridamole on platelet function, hematology, and blood chemistry of saturation divers. Undersea Biomed Res 1979; 6: 127-40.

Philp RB , Schacham P. , Gowdey CW Involvement of platelets and microthrombi in experimental decompression sickness: similarities with disseminated intravascular coagulation. Aerosp Med 1971; 42 : 494-502.

Vroman L. , Adams AL , Klings M. Interactions among human blood proteins at interfaces. Fed Proc 1971; 30 : 1494-1502.

Harvey EN , Barnes DK , McElroy WD , Whiteley AH , Pease DC , Cooper KW Bubble formation in animals. I. Physical factors. J Cell Comp Physiol 1944; 24: 1-22.

Lee WH , Krumhaar O. , Fonkalsrud EW , Schveide CA , Maloney JW Denaturation of plasma proteins as a cause of morbidity and death after intracardiac operations. Surgery 1961 ; 50: 29-39.

Lee WH Jr , Hairston P. Structural effects on blood proteins at the gas blood interface. Fed Proc 1971 ; 30: 1615-20.

Butler BD , Hills BA Role of lung surfactant in cerebral decompression sickness. Aviat Space Environ Med 1983; 54: 11-15.

Hills BA , Butler BD Migration of lung surfactant to pulmonary air emboli. In: Bachrach AJ, Matzen MM eds, Underwater physiology VII , Washington DC: Undersea Medical Society , 1981: 741-52.

Hallenbeck JM , Bove AA , Moquin RB , Elliott DH Accelerated coagulation of whole blood and cell-free plasma by bubbling in vivo. Aerospace Med 1973; 44 : 712-14.

Adebahr G. Zur Frage der Therapie bei Dekompression-Krankenheit und bei Luftembolie. Z Rechtsmedizin 1971; 68: 225-38.

Warren BA , Philp RB , Inwood MJ The ultrastructural morphology of air embolism: platelet adhesion to the interface and endothelial damage. Br J Exp Path 1973; 54: 163-72.

Thorsen T. , Brubakk A. , Ovstedal T. , Farstad M. , Holmsen H. A method for production of N2-microbubbles in platelet-rich plasma in an aggregometer-like apparatus, and effect on the platelet density in vitro. Undersea Biomed Res 1986; 13: 271-88.

Salzman EW Role of platelets in blood-surface interactions . Fed Proc 1971; 30: 1503-1509.

Salzman EW Cyclic AMP and platelet function. N Engl J Med 1972; 286 : 358-63.

Philp RB , Gowdey CW , Prasad M. Changes in blood lipid concentration and cell counts following decompression sickness in rats and the influence of dietary lipid. Can J Physiol Pharmacol 1967; 45: 1047-59.

Thorsen T. , Dalen H. , Bjerkvig R. , Holmsen H. Transmission and scanning electron microscopy of N2 microbubble-activated human platelets in vitro . Undersea Biomed Res 1987; 14: 45-58.

Landis B. , Baxter J. , Patterson RK Jr , Tauber CE Bender-Gestalt evaluation of brain dysfunction following open-heart surgery . J Pers Assess 1974; 38: 556-62.

Aberg T. , Kihlgren M. Cerebral protection during open heart surgery. Thorax 1977; 32: 525-33.

Lee WH Jr , Miller W. , Rowe J. , Hariston P. , Brady MP Effects of extracorporeal circulation on personality and cerebration. Ann Thorac Surg 1969; 7: 562-70.

Bojar RM , Najafi H. , Delaria GA , Serry C. , Goldin MD Neurological complications of coronary revascularization. Ann Thorac Surg 1983; 36 : 427-32.

Coffey CE , Massey W. , Roberts KB , Curtis S. , Jores RH , Pryor DB Natural history of cerebral complications of coronary bypass graft surgery . Neurology 1983; 33: 1416-21.

Breuer AC , Furlan AJ , Hanson MR et al . Neurologic complications of open-heart surgery. Cleveland Clinic Quarterly 1981; 48: 205-206.

Breuer AC , Furlan AJ , Hanson MR et al . Central nervous system complications of coronary artery bypass graft surgery: a prospective analysis of 421 patients. Stroke 1983; 14: 682-87.

Shaw PJ , Bates D. , Cartlidge Nef , Heariside D. , Julian DG , Shaw DA Early neurological complications of coronary artery bypass surgery. Br Med J 1985; 291 : 1384-86.

Tufo HM , Ostfeld AM , Shekelle R. Central nervous system dysfunction following open-heart surgery. JAMA 1970; 212: 1333-40.

Lee WH , Brady MP , Rowe JM , Miller WC Effects of extracorporeal circulation upon behavior, personality and brain function. Ann Surg 1971; 173: 1013-23.

Branthwaite MA Detection of neurological damage during open heart surgery. Thorax 1973; 28: 464-72.

Aberg T. , Kihlgren M. Effect of open heart surgery on intellectual function. Scand J Thorac Cardiovasc Surg 1974; S15: 4-63.

Newman S. The incidence and nature of neuropsychological morbidity following cardiac surgery. Perfusion 1989; 4: 93-100.

Aberg T. , Ronquist G. , Tyden H. et al. Adverse effects on the brain in cardiac operations as assessed by biochemical, psychometric, and radiologic methods. J Thorac Cardiovasc Surg 1984; 87: 99-105.

Hill JD , Aguilar MJ , Baranco A. , de Lanerolle P. , Gerbode F. Neuropathological manifestations of cardiac surgiery. Ann Thorac Surg 1969; 7 : 409-14.

Brierly JB Brain damage complicating open heart surgery (a neuropathologic study). Proc Roy Soc Med 1967; 60: 858-59.

Sotaniemi KA Brain damage and neurological outcome after open-heart surgery. J Neurol Neurosurg Psychiatry 1980; 43: 127-35.

Branthwaite MA Prevention of neurological damage during open-heart surgery. Thorax 1975; 30: 258-61.

Wells DG , Podolakin W. , Mohr M. , Buxton B. , Bray H. Nitrous oxide and cerebrospinal fluid markers of ischaemia following cardiopulmonary bypass. Anaesth Inten Care 1987; 15: 431-35.

Kennedy JH , Hwang Nhc , von Miller SG , Hartman A. Factors influencing distribution of cerebral gas embolism. Cryobiology 1974; 11: 483-92.

Chase WH Anatomical experimental observations on air embolism. Surg Gynecol Obstet 1934; 59: 569-77.

Holt EP , Webb WR , Cook WA , Unal MO Air embolism. Hemodynamics and therapy. Ann Thorac Surg 1966; 2: 551-60.

Glenn Wwl , Sewell WH Jr. Experimental cardiac surgery. IV. The prevention of air embolism in open heart surgery, repair of intraauricular septal defects. Surgery 1953; 34 : 195-206.

Rukstinat G. Experimental air embolism of the coronary arteries. JAMA 1931 ; 96: 26-28.

Malette WG , Fitzgerald JB , Eiseman B. Aeroembolus: a protective substance. Surg Forum 1960; 11 : 155-56.

Eiseman B. , Baxter BJ , Prachuabmoh K. Surface tension reducing substances in the management of coronary air embolism. Ann Surg 1959; 149 : 374-80.

Kurusz M. , Schneider B. , Brown JP , Conti VR Filtration during open-heart surgery: devices, techniques, opinions and complications. Proc Am Acad Cardiovasc Perf 1983; 4: 123-29.

Kurusz M. Arterial line filtration during cardiopulmonary bypass: history and controversy . Proc Am Acad Cardiovasc Perf 1983 ; 4: 76-86.

Gourlay T. , Gibbons M. , Fleming J. , Taylor KM Performance characteristics of a new arterial line filter. Perfusion 1987; 2: 19-26.

Galletti PM , Brecher GA Heart-lung bypass. New York: Grune & Stratton, 1962: 156-59.

Pascale F. Removal of gaseous microemboli from extracorporeal circulation. Med Instrum 1985; 19 : 70-72.

Smith Plc. Interventions to reduce cerebral injury during cardiac surgery - introduction and the effect of oxygenator type. Perfusion 1989; 4: 139-45.

Spielburg R. , Matkovich VI Gas microemboli detection, quantitation and elimination. Chem Eng Commun 1986 ; 47: 1785-83.