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The Journal of Thoracic and Cardiovascular Surgery, Vol 86, 202-208, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
L Henriksen, E Hjelms and T Lindeburgh
Cerebral blood flow (CBF) was measured by intra-arterial injection of xenon
133 in 29 patients during cardiac operations. Marked changes occurred in
all patients. A normal and significant correlation with temperature and
plasma PCO2 (p less than 0.01) support the reliability of the method. Mean
CBF measured between sternotomy and the onset of extracorporeal circulation
(ECC) was 38 ml/100 gm . min. The first minute of ECC was associated with a
decrease in CBF in nine of 12 patients (p less than 0.02). During
steady-state hypothermic ECC (temperature 29 degrees C), CBF increased
unexpectedly to 64 ml/100 gm . min (p less than 0.01). Following rewarming
steady-state normothermic ECC, mean CBF decreased to 42 ml/100 gm . min
with signs of impairment of cerebral autoregulation. Ten and 20 minutes
after termination of ECC, mean CBF was 40 and 41 ml/100 gm . min,
respectively. Arterial PCO2 was found to be important in regulating CBF.
The cerebral autoregulation maintained CBF down to arterial pressures of
around 55 mm Hg. Below this level, CBF was significantly correlated with
perfusion pressure (p less than 0.01). Multiple small emboli with a
hyperemic border zone could cause a brain hyperperfusion, as seen in our
patients during bypass. Measurements of CBF during ECC hold promise as a
guide toward safer cardiac operations.
ARTICLES
Brain hyperperfusion during cardiac operations. Cerebral blood flow measured in man by intra-arterial injection of xenon 133: evidence suggestive of intraoperative microembolism
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