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Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure

Abdulraouf M Z Jijeh1,2,3, Anis Fatima1, Mohammad A Faraji4

  • 1Department of Cardiology, Division of Pediatric Cardiac Intensive Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

Critical Care Explorations
|May 2, 2024
PubMed

Insights

The Glenn procedure significantly increases intracranial pressure (ICP) in infants with congenital heart disease, despite a trend toward improved cerebral perfusion pressure (CPP). This highlights complex cerebrovascular autoregulation post-surgery.

Area of Science:

  • Pediatric Cardiology
  • Neurocritical Care
  • Congenital Heart Disease

Background:

  • Infants with congenital heart disease (CHD) undergoing the Glenn procedure face unique physiological challenges.
  • Understanding changes in intracranial pressure (ICP) and cerebral hemodynamics is crucial for managing these patients.

Purpose of the Study:

  • To investigate alterations in ICP and cerebral hemodynamics in infants with CHD post-Glenn procedure.
  • To explore the relationship between superior vena cava pressure and estimated ICP.

Main Methods:

  • A single-center prospective cohort study involving 27 infants with CHD.
  • Transcranial Doppler (TCD) ultrasound was used to assess cerebral hemodynamics at baseline, postoperatively, and at discharge.
  • Estimated ICP and cerebral perfusion pressure (CPP) were calculated.

Main Results:

  • A significant postoperative increase in estimated ICP was observed (11 to 15 mm Hg, p=0.002).
  • A trend towards higher CPP was noted postoperatively (22 to 28 mm Hg, p=0.1).
  • TCD indices indicated altered cerebral hemodynamics, including decreased diastolic and mean flow velocities and increased pulsatility index.

Conclusions:

  • The Glenn procedure substantially increases estimated ICP in infants with CHD.
  • Cerebral hemodynamics are significantly impacted, necessitating careful monitoring.
  • These findings emphasize the complex cerebrovascular autoregulation in maintaining brain perfusion in this population.
Abstract

Keywords:
Glenn procedurecerebral blood flowcongenital heart defectsintracranial pressuresuperior vena cavatranscranial Doppler sonography

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