Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease

Abstract

Palliative surgery is often performed in the treatment of congenital heart disease. Two representative palliative procedures are the systemic pulmonary shunt and pulmonary artery banding. Dramatic changes in cerebral hemodynamics may occur in these operations due to changes in the pulmonary-tosystemic blood ow ratio and systemic oxygenation. However, there seem to be almost no studies evaluating them. Accordingly, we evaluated cerebral perfusion by transcranial Doppler ultrasonography and cerebral oxygenation by near infrared spectroscopy during these procedures.In the post hoc analysis of a previous prospective observational study, cerebral blood ow velocities of the middle cerebral artery measured by transcranial Doppler were compared between the start and end of surgery as were the pulsatility index and resistance index. The cerebral oxygenation values were also compared between the start and end of surgery.Twenty-two infants with systemic pulmonary shunt and 20 infants with pulmonary artery banding were evaluated. There were no signi cant differences of the ow velocities between the start and end of surgery in either procedure. The pulsatility index signi cantly increased after pulmonary artery banding, which may compete with the increase in cerebral perfusion due to the increase in systemic blood ow. The cerebral oxygenation slightly, but signi cantly, decreased in both procedures, possibly due to an increase in body temperature. Arterial oxygen saturation was almost the same before and after both procedures.Contrary to our expectation, the changes in cerebral hemodynamics in the palliative operations were small if the management of physiological indices such as arterial oxygen saturation was properly performed during the procedures.

The Year in Review: Anesthesia for Congenital Heart Disease 2022

“…The report illustrates that developing a standardized approach to neurophysiologic monitoring is not only feasible, but it is also effective at monitoring cerebral hemodynamics during cardiac surgery. 47,48 Interestingly, this multimodal approach suggests that various neuromonitoring techniques may be complementary rather than exclusive.…”