Intraoperative trans-fontanellar cerebral ultrasonography in infants during cardiac surgery under cardiopulmonary bypass: an observational study

Abstract

This study was performed to evaluate the feasibility of intraoperative point-of-care trans-fontanellar cerebral ultrasonography (TFCU) to obtain blood flow velocity (BFV) reference values at the internal carotid arteries (ICAs) and peri-callosal part of the anterior cerebral artery (pACA) during pediatric cardiac surgery under cardiopulmonary bypass (CPB). TFCU was performed at three time points (after induction of anesthesia, during CPB, after CPB) in 35 infants. BFV was measured at both ICAs and pACA through the anterior fontanelle with an ultrasound sector probe. We divided patients into Group S (<5 kg, n = 16) and Group L (≥5 kg, n = 19) for comparisons according to weight. We also analyzed BFV in low cerebral regional oxygen saturation (rSO) data. All measurements of the BFV at both the ICAs and the pACA were possible. BFVs at the ICAs were lower in Group S than in Group L at all three time points. BFVs at the pACA were similar in both groups except higher value in Group L after CPB. When the rSO was <50, most BFVs (14 of 15 measurements) were lower than the median BFV value during CPB. However, a low rSO did not always reflect low BFV before and after CPB. Point-of-care TFCU can determine BFV at the ICAs and pACA during pediatric cardiac surgery. BFV differs according to the patient's size and CPB application. TFCU can be a practical cerebral blood flow monitoring method when rSO changes without any specific reason in infants.ClinicalTrials.gov NCT01996020.

Goal-directed-perfusion in neonatal aortic arch surgery

“…Nowadays, transfontanellar ultrasound has become routine analysis in pediatric patients whose fontanelles are not closed. It can be applied as a point-of-care method during cardiac surgery (35) and provides additional information regarding morphology of the whole brain, including detection of brain lesions, measurement of TAV and 3-dimensional (3D)-imaging of various blood vessels. It is currently our routine to investigate cerebral blood flow to both hemispheres during RCP, using combined transfontanellar/transtemporal ultrasound and bilateral frontal rSO 2 .…”

Feasibility of Doppler Ultrasound for Cortical Cerebral Blood Flow Velocity Monitoring During Major Non-cardiac Surgery of Newborns

“…Doppler ultrasound is particularly feasible in neonates because of the open anterior fontanel, and is frequently used in the neonatal intensive care to screen for intracranial hemorrhages or thrombosis (7). Recently measuring cortical CBFV has been introduced during neonatal cardiac surgery under cardiopulmonary bypass (8).…”

Visualization of two-dimensional transverse blood flow direction using optical coherence tomography angiography

“…Assessment of vessel patency and blood flow direction is critical in various medical situations, including diagnosis and treatment monitoring of ischemic diseases [1][2][3][4][5][6][7][8] and image-guided vascular surgeries. [9][10][11][12][13][14][15][16][17][18][19][20][21] Ischemic diseases are typically characterized by the disruption of the blood flow, such as changes in blood flow speed and blood flow direction. 11 In the treatment of ischemic diseases, the natural and procedurally promoted vascular remodeling of existing arterial interconnections to form adequate collateral development for restoration of perfusion to the organs that have suffered ischemia is closely related to the patient outcomes.…”

“…[2][3][4][5][6][7] Non-invasive monitoring of blood flow direction and occasional flow direction reversal in the treatment of ischemic diseases can provide important information to assess therapeutic effectiveness. [1][2][3][4][5] In various vascular surgeries such as vascular bypass, [13][14][15][16][17] vascular shunt, 5,[18][19][20][21] and aneurysm surgery, 9,10,14,17 blood flow characteristics such as blood flow path and blood flow direction are intentionally modified. Imaging the blood flow direction during the surgeries that confirms the intended changes of the paths and directions of the blood flow while avoiding any unintended alteration in vessel patency and blood flow direction is highly desirable for monitoring of the immediate effects of the surgery and for quality control of the vascular intervention.…”

“…5,9,10 While optical coherence tomography angiography (OCTA) is the most widely used functional form of optical coherence tomography (OCT) that visualizes three-dimensional vasculature without a need of exogenous contrast agent injection, [22][23][24][25][26] inability to provide information of blood flow direction is one of its limitations. Doppler ultrasound [3][4][5][8][9][10][11][12][13]20 and Doppler OCT [27][28][29] have been main imaging tools used for measuring the flow direction. However, the Doppler techniques can only provide the axial flow direction, whether the flow moves toward or away from the imaging wave source, and therefore usually visualize the axial flow directions in crosssectional images.…”