HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kazumasa Orihashi Yuichiro Matsuura Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Orihashi, K. Articles by Okada, K. Search for Related Content PubMed PubMed Citation Articles by Orihashi, K. Articles by Okada, K.

J Thorac Cardiovasc Surg 1997;114:1081-1087
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

FLOW VELOCITY OF CENTRAL RETINAL ARTERY AND RETROBULBAR VESSELS DURING CARDIOVASCULAR OPERATIONS

Received for publication Oct. 17, 1996 Revisions requested Dec. 31, 1996 Revisions received June 3, 1997 Accepted for publication June 13, 1997 Address for reprints: Kazumasa Orihashi, MD, First Department of Surgery, Hiroshima University School of Medicine, Kasumi 1-2-3, Minami-ku, Hiroshima, 734 Japan.

Abstract

Objective: Both blood flow monitoring and pressure monitoring are necessary to avoid inadequate cerebral perfusion during cardiovascular operations. Inasmuch as transcranial Doppler ultrasonography does not provide a consistently good signal, especially during cardiopulmonary bypass, we examined the blood flow through the central retinal artery, which has proved to reflect an obstruction of the carotid artery. Method: Twenty-eight consecutive cases were examined with a 5 or 7.5 MHz conventional echocardiographic probe. Correlation between the maximal velocity at the central retinal artery and systolic blood pressure was examined. The blood flow of the central retinal artery and retrobulbar vessels was examined during selective or retrograde cerebral perfusion or intraaortic balloon pumping. Results: Blood flow could be clearly visualized but disappeared below a certain pressure in every case. With data from 478 measuring points, systolic blood pressure correlated with maximal velocity ( r = 0.6902, p < 0.0001). The blood pressure–axis intercept, known as "critical closing pressure," was 35.8 ± 14.8 mm Hg, varying among individuals and bilateral eyes. Pulsatility index increased after cardiopulmonary bypass (1.095 ± 0.245 to 1.525 ± 0.268, p < 0.0001). Patency of the circle of Willis was confirmed by the blood flow during anastomosis of the ipsilateral artery. During retrograde cerebral perfusion, blood flow was detectable at the retrobulbar vessels. During intraaortic balloon pumping, the central retinal artery flow was augmented on inflation of the balloon. Conclusion: Orbital vessel monitoring provides the critical closing pressure of the central retinal artery and confirms patency of the circle of Willis. The eye can be "an acoustic window" into intracranial blood flow during cardiovascular surgery.

This article has been cited by other articles:

				M Buyukates, S Kargi, O Kandemir, E Aktunc, S. Turan, and A Atalay The use of the retinal nerve fiber layer thickness measurement in determining the effects of cardiopulmonary bypass procedures on the optic nerve Perfusion, November 1, 2007; 22(6): 401 - 406. [Abstract] [PDF]

				K. Orihashi, T. Sueda, K. Okada, and K. Imai Malposition of selective cerebral perfusion catheter is not a rare event Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 644 - 648. [Abstract] [Full Text] [PDF]

				K. Orihashi, T. Sueda, K. Okada, and K. Imai Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion Eur. J. Cardiothorac. Surg., November 1, 2004; 26(5): 907 - 911. [Abstract] [Full Text] [PDF]

				K. Orihashi, Y. Matsuura, T. Sueda, H. Shikata, M. Watari, and K. Okada Clinical implication of orbital ultrasound monitoring during selective cerebral perfusion Ann. Thorac. Surg., February 1, 2001; 71(2): 673 - 677. [Abstract] [Full Text] [PDF]

				K. Orihashi, Y. Matsuura, T. Sueda, M. Watari, K. Okada, Y. Sugawara, and O. Ishii Aortic arch branches are no longer a blind zone for transesophageal echocardiography: A new eye for aortic surgeons J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 466 - 472. [Abstract] [Full Text] [PDF]