[Transcranial Doppler monitor in the case of selective cerebral perfusion]

Six patients underwent ascending aorta and aortic arch replacement for aneurysmal disease between 1991.12-1992.2 using the cardiopulmonary bypass technique with selective cerebral perfusion from right axillary artery. For four patients, intraoperative transcranial Doppler monitorings of left MCA flow velocity were done. We added left carotid artery perfusion for 5 patients because of old age; 1, intraoperative finding of anisocoria; 1 and low left MCA flow velocity on the TCD monitor; 3. After the addition of left side perfusion, the left MCA flow velocity on the TCD monitor recovered to normal level in the 3 patients. TCD reflected the cerebral perfusion state every minutes and seemed to be very useful monitor in selective cerebral perfusion. It also suggested that unilateral cerebral perfusion does not supply enough blood flow in contralateral side of brain in many cases. To another patient who also underwent aortic arch replacement, we examined preoperatively left MCA flow velocity on the TCD monitor under left carotid artery compression. This "carotid artery compression test" was thought to suggest the degree of right to left intracranial collateral blood flow via Willis's circle. TCD image, when the left carotid artery was clamped, was compared with the result of preoperative "carotid artery compression test". But we can't evaluate the results quantitatively now.