Cerebral blood flow velocities monitored by transcranial Doppler during cardiac catheterizations in children

Abstract

Transcranial Doppler (TCD) was used to evaluate brain circulation during cardiac catheterizations in 32 children requiring pulmonary (n=10) or aortic balloon dilatations (n=2), ductus arteriosus coil insertions (n=5), or angiography (n=15). Cerebral blood flow velocity (CBFV) in the middle cerebral artery was measured before (baseline), during, and after each procedure (mean ± 95%ci). High‐intensity transient signals (HITS) were also detected during these maneuvers. Balloon angioplasty decreased CBFV by 63 ± 11% from baseline (P < 0.01). Shorter durations of the inflation cycle resulted in earlier CBFV recovery (r=0.78). During angiography, CBFV increased by 11 ± 4% (P < 0.01) in all except one case that showed retrograde diastolic flow. Mean total HITS count was 44 (95%ci.limits:27,74). These signals were more frequently found in septal defects or systemic arterial manipulations. Pediatric cardiac catheterization may impose transient fluctuations in brain perfusion as indicated by TCD, but their clinical implications are uncertain. CBFV changes during balloon angioplasty emphasize the importance of rapid inflation/deflation cycles. TCD can monitor such changes and evaluate preventive measures. Cathet. Cardiovasc. Diagn. 43:282–290, 1998. © 1998 Wiley‐Liss, Inc.

Cerebral High‐Intensity Transient Signals during Pediatric Cardiac Catheterization: A Pilot Study Using Transcranial Doppler Ultrasonography

“…As we are not aware of published studies using the Sonara™ (Natus Medical Inc., Pleasanton, CA) TCD system for emboli detection in children with CHD undergoing cardiac catheterization, and performance of this system under these circumstances is unknown. We seemed to observe a larger burden of emboli in either clusters or curtains as compared to previous reports . Quantification of HITS close in time (embolic showers) is a major limitation of currently available TCD systems.…”

“…Maneuvers during catheterization for closure of atrial septal defects, namely, sheath placement, balloon sizing, and device placement, have been associated with HITS in children and young adults . Although not recorded for our study, other procedures in the catheterization laboratory, such as blood sampling and injection of drugs, fluids, and contrast agents, have also been reported to produce HITS . Published studies vary in the TCD device and associated software used, Doppler settings, definition of HITS, calculation of HITS (manual and/or automated), and number of cerebral arteries insonated (Table ).…”

“…23,28 Although not recorded for our study, other procedures in the catheterization laboratory, such as blood sampling and injection of drugs, fluids, and contrast agents, have also been reported to produce HITS. 26,29 Published studies vary in the TCD device and associated software used, Doppler settings, definition of HITS, calculation of HITS (manual and/or automated), and number of cerebral arteries insonated (Table 3). In our small cohort, we found a higher number of HITS compared to those studies cited in Table 3.…”

Intracardiac Shunting and Stroke in Children: A Systematic Review

“…21 A higher count was observed in patients with known septal defects. Similarly, high intensity transient signals were noted in 12 out of 13 children monitored continuously by transcranial Doppler during scoliosis surgery.…”

Cerebral monitoring in children

“…TCD has become routinely used for assessing intracerebral circulation in adult and pediatric patients. In fact, TCD has already been used for the noninvasive monitoring of CBF (3,4), CPP (5) and ICP (6). Normal velocity values for the middle cerebral artery (MCA) are shown in Table 1, and a normal TCD recording is shown in Figure 1.…”