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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 71-78, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LG Svensson, E Rickards, A Coull, G Rogers, CJ Fimmel and RA Hinder
No satisfactory explanation exists as to why paraplegia occurs despite
distal aortic perfusion during thoracic aortic operations. We studied the
hemodynamics, paraplegia rate, and spinal cord blood flow with radioactive
microspheres in 17 male adult baboons, with particular reference to the
arteria radicularis magna. The groups consisted of control animals,
subjected to cross-clamping for 60 minutes, and animals with aorto-aortic
shunts operational for 60 minutes. There were no significant left
ventricular hemodynamic advantages with shunting. Shunting significantly
increased lumbar spinal cord blood flow (p = 0.0009), which correlated with
the distal aortic mean pressure (r = 0.59, p = 0.008). However, lower
thoracic spinal cord blood flow did not increase during shunting (p = 0.2)
and did not correlate with the distal aortic pressure (r = 0.11, p = 0.64).
This is due to the vascular anatomy of the anterior spinal artery, which
was, as in man, smaller above (0.278 mm) than below (0.744 mm) the entry of
the arteria radicularis magna. Resistance to flow, as calculated by
Poiseuille's equation, was 51.7 times greater up the anterior spinal artery
as compared with down this artery. The vascular anatomy explains the
absence of paraplegia in one baboon in the cross-clamp group and paraplegia
in one baboon in the shunt group. Thus, distal aortic perfusion protects
the spinal cord below the arteria radicularis magna but not above it.
ARTICLES
Relationship of spinal cord blood flow to vascular anatomy during thoracic aortic cross-clamping and shunting
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