[Isolated cerebral and myocardial perfusion during aortic arch repair in neonates].

Abstract

OBJECTIVES:

To prevent possible neurologic injury after hypothermic circulatory arrest, aortic arch obstruction with cardiac defects is repaired in one stage using isolated cerebral and myocardial perfusion (ICMP). This study investigated serum S-100 protein(S-100) levels in neonates undergoing ICMP.

METHODS:

Between February 2000 and January 2001, 19 neonate patients underwent repair of critical congenital heart defects. Seven of these patients with aortic coarctation(n = 3) or interrupted aortic arch (n = 4) with ventricular septal defect(ICMP group) underwent primary total repair. An arterial cannula was inserted either into the ascending aorta or into a polytetrafluoroethylene graft which was anastomosed to the innominate artery. During arch repair, a cross-clamp was placed between the innominate and left carotid arteries, and an end-to-end arch anastomosis was performed with cerebral perfusion and heart beating. During ICMP the flow was reduced to maintain a radial artery pressure of 30-45 mmHg. The remaining 12 patients underwent complete transposition of great arteries(n = 9) or total anomalous pulmonary venous connection(n = 3) using a cardiopulmonary bypass(CPB) with flow of 150-180 ml/kg/min(control group). Sequential blood samples for S-100 determinations were taken after induction of anesthesia, 30 min after aortic declamping(post-ACC), 30 min after CPB, and 24 hr after CPB.

RESULTS:

There were no early and late deaths. Neurologic symptoms were not observed in any patients. Mean ICMP time in ICMP group was 17 +/- 4 min. In all patients, S-100 showed the highest value post-ACC and then declined with time. There were no differences in S-100 between the groups at any other time point.

CONCLUSIONS:

Selective cerebral perfusion through the innominate artery may be able to maintain brain circulation.

• Authors: Z Masuda, K Ishino, G Kato, A Ito, T Asai, M Kuriyama, Y Oshima, M Kawada, S Sano
• Journal: Journal of cardiology (J Cardiol) Vol. 38 Issue 3 Pg. 163-8 (Sep 2001) ISSN: 0914-5087 [Print] Netherlands
• PMID: 11577613 (Publication Type: English Abstract, Journal Article)

Chemical References

• S100 Proteins

Topics

• Aorta, Thoracic (abnormalities, surgery)
• Aortic Coarctation (surgery)
• Cerebrovascular Circulation (physiology)
• Coronary Circulation (physiology)
• Humans
• Infant, Newborn
• Perfusion (methods)
• S100 Proteins (blood)