Equal cerebral perfusion during extended aortic coarctation repair

Area of Science:

• Pediatric Cardiac Surgery
• Medical Imaging
• Neonatal Cardiology

Background:

• Aortic coarctation with distal aortic arch hypoplasia requires surgical repair.
• Unilateral cerebral perfusion (UCP) is used during repair, but its cerebral blood flow distribution is not fully understood.
• Transfontanellar contrast-enhanced ultrasound (T-CEUS) allows real-time visualization and quantification of cerebral blood flow.

Purpose of the Study:

• To quantitatively evaluate cerebral perfusion during coarctation resection with extended end-to-end-anastomosis (REEEA) using intraoperative T-CEUS.
• To assess the distribution of cerebral blood flow during unilateral cerebral perfusion (UCP).

Main Methods:

• Prospective study of 9 infants undergoing REEEA with open fontanelles.
• Intraoperative T-CEUS was performed at three time-points: pre-surgery, during UCP, and post-surgery.
• Software-based analysis of 11 parameters evaluated absolute and relative blood flow in both hemispheres compared to baseline.

Main Results:

• No significant side-dependent differences in absolute or relative cerebral perfusion were observed during REEEA.
• An increased relative 'wash-out-rate' favoring the right hemisphere was noted post-surgery (P=0.0013).
• During UCP, 'rise time' and 'time-to-peak' were transiently increased in one or both hemispheres.

Conclusions:

• Intraoperative T-CEUS confirmed homogenous contrast agent distribution in both hemispheres during UCP.
• T-CEUS is a viable tool for evaluating cerebral perfusion in congenital cardiac surgery.
• This technique aids in assessing brain blood flow during complex neonatal cardiac procedures.