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Age-Related Changes in Cerebral Hemodynamics in Children Undergoing Congenital Cardiac Surgery: A Prospective
Liping Sun1, Kan Zhang1, Hualin Chen2
1Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Pediatric cardiac surgery alters cerebral hemodynamics, with significant changes in resistance index (RI) observed, particularly in younger children. Cerebral blood flow velocity increased with age, but regional cerebral oxygen saturation remained unaffected post-surgery.
Area of Science:
- Pediatric Cardiology
- Neuroscience
- Medical Imaging
Background:
- Congenital heart disease (CHD) affects cerebral hemodynamics in children.
- Understanding age-related changes in cerebral blood flow is crucial for managing pediatric patients undergoing cardiac surgery.
Purpose of the Study:
- To investigate age-related changes in cerebral hemodynamic characteristics before and after pediatric cardiac surgery.
- To assess the impact of cardiopulmonary bypass on cerebral hemodynamics in children with CHD.
Main Methods:
- Prospective observational study involving 44 children (0-6 years) with CHD.
- Cerebral hemodynamics measured using transcranial color-coded duplex sonography, including resistance index (RI), pulsatility index (PI), and cerebral blood flow velocity (CBFV).
- Regional cerebral oxygen saturation (rScO2) and vital signs were also monitored.
Main Results:
- RI and PI decreased exponentially with age, both pre- and post-surgery.
- Post-cardiac surgery, RI significantly decreased, especially in children >18 months.
- CBFV increased exponentially with age, while rScO2 increased linearly; surgery did not alter rScO2.
Conclusions:
- Age-related cerebral hemodynamic patterns are present in children with CHD.
- Cardiopulmonary bypass surgery induces greater cerebrovascular dilation in younger children (≤18 months) compared to older children (>18 months).
Objective:
To explore age-related cerebral hemodynamic characteristics before and after pediatric cardiac surgery.
Design:
Prospective observational study.
Setting:
Single-center study based at a tertiary care center in Shanghai, China.
Patients:
Fifty-three children with congenital heart disease (CHD) aged zero-to-six years undergoing cardiac surgery with cardiopulmonary bypass were enrolled, and 44 children finally were analyzed.
Intervention:
Cerebral hemodynamics were measured by transcranial color-coded duplex sonography in the right temporal window before and after surgery. The resistance index (RI), pulsatility index (PI), and cerebral blood flow velocity (CBFV), including time average maximum flow velocity (Vtamax), mean blood flow velocity (Vmean), and the peak systolic flow velocity (Vpeak), of the right middle cerebral artery (MCA) and regional cerebral oxygen saturation (rScO2) of the right frontal lobe were measured and analyzed. Heart rate and mean arterial pressure were also recorded during ultrasound.
Measurements And Main Results:
RI and PI decreased exponentially with age before and after cardiac surgery. While PI remained unchanged after cardiac surgery, RI was significantly reduced. Furthermore, RI reduction after cardiac surgery was more significant in children >18 months compared to those ≤18 months. CBFV of the right MCA also showed exponential increase with age, but rScO2 linearly increased. Cardiac surgery significantly changed the cerebral hemodynamics, but it did not affect rScO2 in children regardless of age.
Conclusions:
Age-related cerebral hemodynamic changes exist in children with CHD. Cardiopulmonary bypass surgery led to greater cerebrovascular dilation in children aged ≤18 months than those >18 months.
