Major embolic complications of open heart surgery and DDA.

To the Editor: I read with interest the article by Furlan & Brueur on "Central Nervous System Complications of Open Heart Surgery". DDA is a variant of atherosclerosis which includes patients with "brittle aortas" wherein showers of cholesterol emboli repeatedly occur spontaneously or from trauma. I believe it is possible that a relatively high percentage of patients who suffered major embolic complications from open heart surgery had DDA. It would be of interest to know whether there was any evidence for a preponderance of this disorder pre-operatively in patients who had post-operative CNS complications. Pre-surgical erythrocyte sedimentation rates, cranial CT scans showing small lacunar-type infarcts especially in the caudate nuclei and a history of ischemic disturbances including the gastrointestinal system might be considered presumptive evidence of pre-existing low-grade DDA. 1 agree with the author's search for defects in cerebral auto-regulation in such patients but perhaps also one should search for sensitive indicators of low-grade chronic cholesterol embolization pre-operatively in such patients. Moreover anticoagulation might be withheld or reduced in such patiens because there is evidence that such patients have a greater risk of complications from anticoagulation.