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

This Article Full Text Full Text (PDF) 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): Anthony Azakie Tom R. Karl Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Azakie, A. Articles by McQuillen, P. S. Search for Related Content PubMed PubMed Citation Articles by Azakie, A. Articles by McQuillen, P. S. Related Collections Cerebral protection Congenital - acyanotic

J Thorac Cardiovasc Surg 2005;130:830-836
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Cerebral oxygen balance is impaired during repair of aortic coarctation in infants and children

^a Department of Surgery, University of California, San Francisco, Calif.
^b Department of Anesthesia, University of California, San Francisco, Calif.
^c Department of Neurology, University of California, San Francisco, Calif.
^d Department of Pediatrics, University of California, San Francisco, Calif.

Presented at Scientific Sessions of the American Heart Association, New Orleans, La, 2004.

Received for publication February 23, 2005; revisions received April 1, 2005; accepted for publication April 12, 2005.

^_* Address for reprints: Patrick McQuillen, MD, 505 Parnassus Ave, Room M680, San Francisco, CA 94143-0106. (Email: psmcq{at}itsa.ucsf.edu).

OBJECTIVE: During repair of aortic coarctation through a left thoracotomy without cardiopulmonary bypass, clamping the proximal transverse aortic arch occludes antegrade flow to the left carotid and vertebral arteries. It is assumed that flow through the right carotid and vertebral arteries is adequate for cerebral perfusion. The study objective is to determine whether aortic occlusion impairs left hemispheric cerebral oxygen balance measured by near-infrared spectroscopy.

METHODS: In 18 children having repair of aortic coarctation, we measured the maximum change and integral for hemoglobin D (difference of oxyhemoglobin and deoxyhemoglobin), total oxygenation index, and the redox state of cytochrome aa3. Thirteen subjects had recordings from the left hemisphere to test the hypothesis that aortic occlusion impairs left hemispheric oxygen balance. Five subjects had recordings from the right hemisphere for comparison.

RESULTS: After aortic clamping, a significant decrease in hemoglobin D was observed in recordings from the left hemisphere compared with those from the right hemisphere (P = .03, maximum change in hemoglobin D). Total oxygenation index and cytochrome aa3 were generally preserved. There was an inverse linear relationship for the change in hemoglobin D during clamp application and after removal (Spearman rho = –0.74), with increased hemoglobin D after clamp removal in those subjects with the greatest decrease of hemoglobin D during arch occlusion. Linear regression analysis identified nitroprusside administration as significantly associated with a decrease in hemoglobin D (P < .001).

CONCLUSIONS: Significant impairment in left hemispheric cerebral oxygen balance was identified during arch clamping. The neurodevelopmental significance of impaired cerebral oxygen balance detected by near-infrared spectroscopy during aortic coarctation repair remains to be elucidated.

This article has been cited by other articles:

				A. Farouk, M. Karimi, M. Henderson, J. Ostrowsky, E. Siwik, and H. Hennein Cerebral regional oxygenation during aortic coarctation repair in pediatric population. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 26 - 31. [Abstract] [Full Text] [PDF]

				G. Gargiulo, G. Oppido, E. Angeli, and C. P. Napoleone Neonatal aortic arch surgery MMCTS, July 23, 2007; 2007(0723): 2345. [Abstract] [Full Text] [PDF]

				P. S. McQuillen, A. J. Barkovich, S. E.G. Hamrick, M. Perez, P. Ward, D. V. Glidden, A. Azakie, T. Karl, and S. P. Miller Temporal and Anatomic Risk Profile of Brain Injury With Neonatal Repair of Congenital Heart Defects Stroke, February 1, 2007; 38(2): 736 - 741. [Abstract] [Full Text] [PDF]