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LETTERS TO THE EDITOR

Transcranial Doppler Technique for Monitoring the Efficacy of Selective Antegrade Cerebral Perfusion

Department of Anesthesiology University Hospital Groningen, Groningen, The Netherlands

I would like to report on the use of transcranial Doppler (TCD) as a monitoring tool for the efficacy of selective antegrade cerebral perfusion (SACP) during circulatory arrest for surgery of the aortic arch.

A 44-yr-old man was scheduled for aortic arch reconstruction because of a large aortic aneurysm. After the induction of anesthesia a 2-MHz TCD transducer was fixated over the left middle cerebral artery. At a nasopharyngeal temperature of 20°C, the right and the left carotid artery were carefully canulated and, via a separate roller pump, perfused with a flow of 300 mL/min. At 300 mL/min, no flow was detected by TCD (Figure 1). The hemoglobin level of the perfusate was 4.2 mmol/L, and pH management during the procedure was alpha-stat. The pump flow was increased, and at a flow of 550 mL/min a stable TCD tracing suddenly appeared (Figure 2), indicating flow in the left middle cerebral artery. This flow was comparable to the flow in the middle cerebral artery on full cardiopulmonary bypass just before SACP. No embolic events were seen. After 40 min, cardiopulmonary bypass was reinstituted. The patient had an uneventful recovery without neurological sequelae.

View larger version (70K): [in this window] [in a new window]   Figure 1. Transcranial Doppler registration of the left middle cerebral artery during selective cerebral perfusion at a flow of 300 mL/min. Three artifacts can be seen, but no flow is present.

View larger version (86K): [in this window] [in a new window]   Figure 2. Transcranial Doppler registration of the left middle cerebral artery during selective cerebral perfusion at a flow of 550 mL/min. A mean flow of 12 cm/s is seen.

References

1. Alamanni F, Agrifoglio M, Pompilio G, et al. Aortic arch surgery: pros and cons of selective cerebral perfusion: a multivariable analysis for cerebral injury during hypothermic circulatory arrest. J Cardiovasc Surg (Torino) 1995;36:31–7.[Medline]
2. Frist WH, Baldwin JC, Starnes VA, et al. A reconsideration of cerebral perfusion in aortic arch replacement. Ann Thorac Surg 1986;42:273–81.[Abstract]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by De Vries, A. J. Search for Related Content PubMed PubMed Citation Articles by De Vries, A. J.