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Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease

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Abstract

Palliative surgery is often performed in the treatment of congenital heart disease. Two representative palliative procedures are the systemic pulmonary shunt and pulmonary artery banding. Dramatic changes in cerebral hemodynamics may occur in these operations due to changes in the pulmonary-to-systemic blood flow ratio and systemic oxygenation. However, there seem to be almost no studies evaluating them. Accordingly, we evaluated cerebral perfusion by transcranial Doppler ultrasonography and cerebral oxygenation by near infrared spectroscopy during these procedures. In the post hoc analysis of a previous prospective observational study, cerebral blood flow velocities of the middle cerebral artery measured by transcranial Doppler were compared between the start and end of surgery as were the pulsatility index and resistance index. The cerebral oxygenation values were also compared between the start and end of surgery. Twenty-two infants with systemic pulmonary shunt and 20 infants with pulmonary artery banding were evaluated. There were no significant differences of the flow velocities between the start and end of surgery in either procedure. The pulsatility index significantly increased after pulmonary artery banding, which may compete with the increase in cerebral perfusion due to the increase in systemic blood flow. The cerebral oxygenation decreased in both procedures, possibly due to an increase in body temperature. Arterial oxygen saturation was almost the same before and after both procedures. Contrary to our expectation, the changes in cerebral hemodynamics in the palliative operations were small if the management of physiological indices such as arterial oxygen saturation was properly performed during the procedures.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan

    Yoshifumi Takeda, Masataka Yamamoto, Koji Hoshino & Yuji Morimoto

  2. Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, N14 W5, Sapporo, 0608648, Japan

    Yoichi M. Ito

  3. Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Sapporo, 060‑8638, Japan

    Nobuyasu Kato & Satoru Wakasa

Authors
  1. Yoshifumi Takeda
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  2. Masataka Yamamoto
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  3. Koji Hoshino
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  4. Yoichi M. Ito
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  5. Nobuyasu Kato
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  6. Satoru Wakasa
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  7. Yuji Morimoto
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Contributions

Conceptualization: [MY, YM]; Methodology: [MY, YM]; Formal analysis and investigation: [YT, YMIY, YM]; Writing—original draft preparation: [YT, YM]; Writing—review and editing: [NK, SW, KH].

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Correspondence to Yuji Morimoto.

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Takeda, Y., Yamamoto, M., Hoshino, K. et al. Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease. Pediatr Cardiol 44, 695–701 (2023). https://doi.org/10.1007/s00246-022-02999-6

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