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

This Article 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): Keiji Ataka Masayoshi Okada Chojiro Yamashita Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yoshimura, N. Articles by Kobayashi, S. Search for Related Content PubMed PubMed Citation Articles by Yoshimura, N. Articles by Kobayashi, S.

J Thorac Cardiovasc Surg 1995;109:591-593
© 1995 Mosby, Inc.

BRIEF COMMUNICATIONS

Ophthalmoscopic findings demonstrate reduced cerebral blood flow during retrograde cerebral perfusion

Kobe, Japan

Retrograde cerebral perfusion (RCP) via the superior vena cava has recently been discussed as an alternative method of cerebral protection during aortic arch operations. ^1,2 This method may be simple and useful because it does not require cannulation and crossclamping of aortic arch vessels, and it may enhance the effect of cerebral protection in circulatory arrest. ³ However, it is not clear whether this procedure provides adequate oxygen supply for the brain. To resolve this problem, we have observed the optic fundus of a patient undergoing an aortic arch operation with RCP to evaluate the circulatory state of the brain during RCP.

A 78-year-old woman was admitted to our hospital because of hoarseness. Computed tomographic scanning and digital subtraction angiography revealed an aneurysm of the distal aortic arch. On December 7, 1993, graft replacement of the distal aortic arch was performed. Median sternotomy was carried out to expose the aortic arch and the aneurysm. A saccular aneurysm, 60 mm in diameter, was located at the origin of the left subclavian artery. After arterial cannulation at the ascending aorta and two separate venous cannulations via the right atrium, cardiopulmonary bypass (CPB) was established and core cooling was performed until a tympanic temperature of 18 ° C was reached. After a brief period of circulatory arrest, the bypass circuit of the CPB was opened and RCP through the superior vena caval cannula was initiated at a flow rate of 400 ml/min. Central venous pressure was maintained between 15 and 18 mm Hg during RCP. Resection of the distal arch aneurysm and creation of the distal and then the proximal anastomoses between the artificial vascular graft and the native aorta were performed during RCP. The left subclavian artery was reconstructed during the rewarming stage of CPB. Extracorporeal circulation time was 255 minutes and RCP time was 70 minutes. The patient awoke 7 hours after the operation and had no neurologic complications.

Fig. 1 shows the ophthalmoscopic findings during the operation. During CPB, the fundus looked normal. The optic disc was nearly circular with sharply outlined edges. The retinal vessels overlying the whole fundus were normally visible. No abnormalities, such as narrowing and irregularity in the arteries and veins, were observed. Arteries were physiologically narrower than the corresponding veins (Fig. 1, A). Both arteries and veins of the retina showed marked constrictions at 15 minutes after the initiation of RCP (Fig. 1, B). The veins were dilated to the normal size at 30 and 60 minutes after the initiation of RCP, although some branches still showed marked constrictions. The large arteries were reduced to thin threads, and the smaller arteries were invisible (Fig. 1, C and D). Blood flow became visible in the large arteries again 15 minutes after CPB was restarted (Fig. 1, E). After the patient was weaned from CPB, the retinal vessels showed complete recovery (Fig. 1, F). The optic disc did not show edematous swelling caused by the elevation of intracranial pressure ⁴ during the operation.

View larger version (507K): [in this window] [in a new window]   Fig. 1. A, Optic fundus appeared normal during CPB. D, Optic disc; A, artery; V, vein. B, Arteries and veins showed marked constriction at 15 minutes after the initiation of RCP. C, Arteries were reduced to thin threads and the smaller arteries were invisible (arrows) 30 minutes after the initiation of RCP. Some branches of the veins showed marked constriction (arrowheads).D, At 60 minutes the optic fundus revealed almost same findings as those at 30 minutes after the initiation of RCP. E, Blood flow became visible in arteries (arrows) at 15 minutes after the initiation of antegrade reperfusion. F, Arteries and veins recovered completely after weaning from CPB.

Footnotes

From the Department of Surgery, Division II,^a and the Department of Ophthalmology,^b Kobe University School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650, Japan.

J THORACTFX CARDIOVASC SURG 1995; 109: 591-3

References

1. Safi HJ, Brien HW, Winter JN, et al. Brain protection via cerebral retrograde perfusion during aortic arch aneurysm repair. Ann Thorac Surg 1993;56:270-6.[Abstract/Free Full Text]
   
2. Takamoto S, Matsuda T, Harada M, Miyata S, Shimamura Y. Simple hypothermic retrograde cerebral perfusion during aortic arch replacement: a preliminary report on two successful cases. J THORAC CARDIOVASC SURG 1992;104:1106-9.[Abstract]
   
3. Usui A, Oohara K, Liu T, et al. Determination of optimum retrograde cerebral perfusion condition. J THORAC CARDIOVASC SURG 1994;107:300-8.[Abstract/Free Full Text]
   
4. Glaser JS. Papilledema of raised intracranial pressure. In: Tasman W, ed. Duane's clinical ophthalmology. Vol 2. Revised ed. Philadelphia: JB Lippincott, 1989:34-9.
   
5. Behrendt T. Normal fundus. In: Tasman W, ed. Duane's clinical ophthalmology. Vol 3. Revised ed. Philadelphia: JB Lippincott, 1991:14-9.
   

This article has been cited by other articles:

				D. L. Reich, S. Uysal, M. A. Ergin, and R. B. Griepp Retrograde cerebral perfusion as a method of neuroprotection during thoracic aortic surgery Ann. Thorac. Surg., November 1, 2001; 72(5): 1774 - 1782. [Abstract] [Full Text] [PDF]

				C H Wong and R S Bonser Retrograde cerebral perfusion: clinical and experimental aspects Perfusion, July 1, 1999; 14(4): 247 - 256. [PDF]

				N. Yoshimura, M. Okada, T. Ota, T. Azami, H. Nohara, K. Ataka, and C. Yamashita Retrograde Cerebral Perfusion for Aortic Arch Operation Vascular and Endovascular Surgery, January 1, 1997; 31(1): 35 - 42. [Abstract] [PDF]

				N. Yoshimura, M. Okada, T. Ota, and H. Nohara What is cerebral metabolism during retrograde perfusion? J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 492 - 493. [Full Text]

This Article 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): Keiji Ataka Masayoshi Okada Chojiro Yamashita Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yoshimura, N. Articles by Kobayashi, S. Search for Related Content PubMed PubMed Citation Articles by Yoshimura, N. Articles by Kobayashi, S.