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J Thorac Cardiovasc Surg 2003;126:1712-1717
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Regional low-flow perfusion provides comparable blood flow and oxygenation to both cerebral hemispheres during neonatal aortic arch reconstruction

^a Division of Pediatric Cardiovascular Anesthesiology Texas Children's Hospital and Baylor College of Medicine, Houston, Tex, USA
^b Division of Congenital Heart Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex, USA

Received for publication February 10, 2003; revisions received May 16, 2003; accepted for publication June 17, 2003.

^* Address for reprints: Dean B. Andropoulos, MD, Texas Children's Hospital, Pediatric Cardiovascular Anesthesiology, 6621 Fannin, WT19345H, Houston TX 77030-2399, USA
dra{at}bcm.tmc.edu

OBJECTIVE: The aim of this study was to measure cerebral oxygenation, cerebral blood volume index, and cerebral blood flow velocity values in both cerebral hemispheres before, during, and after regional low-flow cerebral perfusion for neonatal aortic arch reconstruction and to test the hypothesis that cerebral blood volume index measured by near infrared spectroscopy correlates with cerebral blood flow velocity measured by transcranial Doppler ultrasonography.

METHODS: Bilateral near infrared spectroscopy and transcranial Doppler ultrasonography sensors were placed, and values were recorded immediately before, during, and after regional low-flow cerebral perfusion at 18°C. Cerebral oxygen saturations, cerebral blood flow velocities, and cerebral blood volume index values were compared by Mann-Whitney U test. Correlations between values of cerebral blood volume index and cerebral blood flow velocity were tested with Spearman rank order correlation.

RESULTS: Twenty patients were studied. Median cerebral oxygen saturations for the right and left sides were 95% and 95% before regional low-flow cerebral perfusion, 95% and 87% during regional low-flow cerebral perfusion (P = .054), and 93% and 94% after regional low-flow cerebral perfusion. Median cerebral blood flow velocity values did not change during regional low-flow cerebral perfusion. Cerebral blood volume index exhibited a poor correlation with cerebral blood flow velocity.

CONCLUSIONS: Regional low-flow cerebral perfusion provides comparable blood flows and oxygenation to both cerebral hemispheres. Transcranial Doppler ultrasonography is recommended as a corroborative method with near-infrared spectroscopy to guide flow during regional low-flow cerebral perfusion, because cerebral blood volume index does not correlate with cerebral blood flow velocity.

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