Deep hypothermic circulatory arrest for hemiarch replacement in a pediatric patient with moyamoya disease
Clinical Report
First Online:
Received:
Accepted:
- 192 Downloads
Abstract
Moyamoya disease is a chronic cerebrovascular occlusive disease, occurring predominantly in young populations, that causes cerebral ischemia and hemorrhage. Patients with moyamoya disease are at high risk of neurological complications during cardiac surgery because of perioperative hemodynamic changes. However, there is no established evidence on temperature management during cardiopulmonary bypass. Previous reports described normothermia or mild to moderate hypothermia during cardiopulmonary bypass in patients with moyamoya disease; however, surgical conditions, such as not having enough space to clamp the aorta or a clean surgical field, sometimes force us to use deep hypothermic circuratory arrest. We report a successful case of a pediatric patient with moyamoya disease who underwent deep hypothermic circulatory arrest (18 °C) for hemiarch replacement without neurological complications. Deep hypothermia may be an alternative technique for achieving cerebral protection in the context of moyamoya disease.
Keywords
Moyamoya disease Deep hypothermic circulatory arrest Cardiopulmonary bypassReferences
- 1.Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20:288–99.PubMedCrossRefGoogle Scholar
- 2.Wang N, Kuluz J, Barron M, Perryman R. Cardiopulmonary bypass in a patient with moyamoya disease. Anesth Analg. 1997;84:1160–3.PubMedGoogle Scholar
- 3.Han SH, Kim SD, Ham BM, Kim CS, Bahk JH, Lim C. Normothermic cardiopulmonary bypass in a patient with moyamoya disease. J Cardiothorac Vasc Anesth. 2005;19:499–500.PubMedCrossRefGoogle Scholar
- 4.Gatti G, Benussi B, Gon L, Zingone B. Aortic valve replacement in an adult white male with moyamoya disease and coronary artery fistulas. J Cardiothorac Vasc Anesth. 2007;21:166–8.PubMedCrossRefGoogle Scholar
- 5.Al-Naimi KT, Mediratta NK, Pennefather SH. Hypothermic cardiopulmonary bypass in a patient with moyamoya disease. J Cardiothorac Vasc Anesth. 2009;23:206–7.PubMedCrossRefGoogle Scholar
- 6.Kim CH, Yoon JU, Lee HJ, Shin SW, Yoon JY, Park JY. Hypothermic cardiopulmonary bypass for minimally invasive mitral valve plasty in adult moyamoya disease. J Anesth. 2012;26:259–61.PubMedCrossRefGoogle Scholar
- 7.Greeley WJ, Ungerleider RM, Smith LR, Reves JG. The effects of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg. 1989;97:737–45.PubMedGoogle Scholar
- 8.Guo DC, Papke CL, Tran-Fadulu V, Regalado ES, Avidan N, Johnson RJ, Kim DH, Pannu H, Willing MC, Sparks E, Pyeritz RE, Singh MN, Dalman RL, Grotta JC, Marian AJ, Boerwinkle EA, Frazier LQ, LeMaire SA, Coselli JS, Estrera AL, Safi HJ, Veeraraghavan S, Muzny DM, Wheeler DA, Willerson JT, Yu RK, Shete SS, Scherer SE, Raman CS, Buja LM, Milewicz DM. Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease. Am J Hum Genet. 2009;84:617–27.PubMedCentralPubMedCrossRefGoogle Scholar
- 9.Powers WJ. Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol. 1991;29:231–40.PubMedCrossRefGoogle Scholar
- 10.Baron JC, Bousser MG, Rey A, Guillard A, Comar D, Castaigne P. Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography. Stroke. 1981;12:454–9.PubMedCrossRefGoogle Scholar
- 11.Sato K, Shirane R, Kato M, Yoshimoto T. Effects of inhalational anesthesia on cerebral circulation in moyamoya disease. J Neurosurg Anesthesiol. 1999;11:25–30.PubMedCrossRefGoogle Scholar
- 12.Russo H, Bressolle F. Pharmacodynamics and pharmacokinetics of thiopental. Clin Pharmacokinet. 1998;35:95–134.PubMedCrossRefGoogle Scholar
- 13.Apostolakis E, Akinosoglou K. The methodologies of hypothermic circulatory arrest and of antegrade and retrograde cerebral perfusion for aortic arch surgery. Ann Thorac Cardiovasc Surg. 2008;14:138–48.PubMedGoogle Scholar
- 14.PaepeA De, Malfait F. Bleeding and bruising in patients with Ehlers–Danlos syndrome and other collagen vascular disorders. Br J Haematol. 2004;127:491–500.CrossRefGoogle Scholar
- 15.Cavaglia M, Seshadri SG, Marchand JE, Ochocki CL, Mee RB, Bokesch PM. Increased transcription factor expression and permeability of the blood–brain barrier associated with cardiopulmonary bypass in lambs. Ann Thorac Surg. 2004;78:1418–25.PubMedCrossRefGoogle Scholar
- 16.Cook DJ, Orszulak TA, Daly RC. Minimum hematocrit at differing cardiopulmonary bypass temperatures in dogs. Circulation. 1998;98:II170–4.PubMedGoogle Scholar
- 17.Nussmeler N, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology. 1986;64:165–70.CrossRefGoogle Scholar
- 18.Kurehara K, Ohnishi H, Touho H, Furuya H, Okuda T. Cortical blood flow response to hypercapnia during anaesthesia in Moyamoya disease. Can J Anaesth. 1993;40:709–13.PubMedCrossRefGoogle Scholar
- 19.Takeuchi S, Tanaka R, Ishii R, Tsuchida T, Kobayashi K, Arai H. Cerebral hemodynamics in patients with moyamoya disease. A study of regional cerebral blood flow by the 133Xe inhalation method. Surg Neurol. 1985;23:468–74.PubMedCrossRefGoogle Scholar
Copyright information
© Japanese Society of Anesthesiologists 2014