Цель. Оценка частоты развития цереброваскулярных осложнений, неврологического статуса и состояния головного мозга по данным мультиспиральной компьютерной томографии (МСКТ) у пациентов в отдаленном периоде после коронарного шунтирования (КШ).

Благодаря возможности изучать человеческий мозг in vivo с помощью лучевых методов исследования понимание природы и места возрастных изменений вызывает все больший интерес. Изменения объ- ема мозга с течением времени у здоровых взрослых весьма вариабельны. Хотя уменьшение объема мозга распространено широко, его степень различна в разных регионах мозга. Старение мозга осно- вано на множестве факторов, и у каждого индивида они выражены по-разному. Объем мозга с возрастом уменьшается даже у относительно здоровых взрослых лиц без признаков общего снижения когнитивных способностей. Старение мозга нелинейно, никаких половых различий в возра- стных тенденциях старения мозга не наблюдается. Индивидуальные различия в степени и виде изме- нений существенны и в некоторых важных областях мозга усиливаются или в определенной степени обусловливаются сосудистыми факторами риска.

Aim . To assess the preoperative morphological state of the brain and the state of cerebral circulation in patients referred for coronary bypass surgery to identify predictors of long-term cerebral disorders. Material and Methods . The study included 33 male patients, divided into 2 groups according to the presence or the absence of distant neurological complications 5 years after surgery. All patients underwent non-contrast computed tomography of the brain and perfusion computed tomography. Computed tomography was repeated 5 years after surgery. Results . The perfusion indices in all measurement zones in patients of the two groups did not significantly differ. Significant differences in width of the third ventricle and ventricular-cranial index between patients of groups 1 and 2 were not identified. The incidence rates of leukoaraiosis significantly differed: leukoaraiosis was detected significantly more frequently in group 2 (78% of cases) than in patients of group 1 (31%), p=0.0455. Discussion . The dimensions of the brain cavity system and the preoperative state of the microcirculatory blood flow were not predictors of long-term postoperative neurological disorders. Five years after surgery, patients of group 2 showed clinical and morphological signs of past ischemic changes, which were not detected in patients of group 1 suggesting that leukoaraiosis was an unfavorable prognostic indicator of postoperative cerebrovascular disorders in the long-term period. Conclusion . When referring a patient with the presence of morphological manifestations of cerebral microangiopathy in the form of the leukoaraiosis phenomenon for cardiac surgery, these patients should be considered at risk requiring administration of the necessary set of measures for the prevention of long-term cerebral disorders.

Purpose : evaluation of brain substance’s morphological state and dynamics of cerebral tissue perfusion in patients undergoing on-pump CABG surgery compared preoperative and late postoperative period. Materials and methods . The study included 14 male patients who underwent on-pump CABG surgery. CT and PCT with intravenous bolus radiopaque drug in the cubital vein conducted to all patients in the preoperative period. Cranio-ventricular index, width III ventricle was measured. The presence and degree leukoaraiosis, the presence of cysts, areas of gliosis, CBF, CBV, TTP in symmetric cortical and subcortical regions was recorded. CT and PCT repeat after 5 years. Results. In preoperative period III ventricle width was 6.8 ± 1.4 mm; cranio-ventricular index = 4.9 ± 1.3. It were found cysts on the level of the basal ganglia in two cases (14%). Leukoaraiosis detected in four patients (28%). PCT in the preoperative period noted the absence of blood flow asymmetry, reducing blood flow to the frontal lobes, in the area of the junction of the parietal, temporal and occipital lobes. Significant expansion of the III ventricle 8.5 ± 2.5 mm, reducing cranio-ventricular index 3.6 ± 0.5, increasing the number of cysts and glial changes in 6 (43%) cases,  leukoaraiosis in 8 (57%) cases, a significant increase in TTP in the index of the thalamus (11.5 ± 2.1 sec) was determined after the operation. Conclusions. Сhronic cerebral ischemia revealed progression of  manifestations in the late postoperative period in patients  undergoing on-pump CABG. The identified changes are not a direct  result of on-pump CABG, because similar changes observed in  patients with atherosclerotic lesions of the microvasculature and  damage the blood-brain barrier and also in patients without cardiac surgery.