[Retrograde cerebral perfusion and deep hypothermic systemic circulatory arrest].
This study was carried out in order to find out whether retrograde cerebral perfusion has a beneficial effect on protection of the brain during deep hypothermic circulatory arrest. Six mongrel dogs weighing 11 to 18 Kg were placed on hypothermic cardiopulmonary bypass. After induction of circulatory arrest, retrograde cerebral perfusion was implemented by using the bypass connecting the arterial and venous lines of the extracorporeal circuit to reverse flow into the cranial vena cava in 2 dogs or selective cannulation of bilateral external jugular veins in remained 4 dogs. Retrograde cerebral perfusion was continued for 60 minutes. Each dog was rewarmed, and weaned from cardiopulmonary bypass. During the experiment, electroencephalography and somatosensory evoked potentials were monitored. In one dog, India ink with gelatin was infused retrogradely into bilateral retroarticular veins and the brain subjected to microscopic examination of the distribution of the pigment. The protective effect of retrograde cerebral perfusion for the brain in comparison with deep hypothermic circulatory arrest alone was not demonstrated clearly by electroencephalography and somatosensory evoked potentials. The reason was that the external jugular veins had many functioning valves that obstructed retrograde perfusion and the internal jugular veins were rudimentary in dogs. In the dog with selective infusion of India ink into retroarticular veins, however, wide range of the distribution of the pigment in subarchnoidal venulae was observed. It is suggested that retrograde cerebral perfusion via selected route depends on anatomical variations of the venous drainage from the brain is effective. It is also considered that retrograde cerebral perfusion via the superior vena cava is available for the surgery of the aortic arch and may be beneficial.
Ueda
Y
Y
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
D000818:Animals; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D004285:Dogs; D005112:Extracorporeal Circulation / Q000379:methods; D006324:Heart Arrest, Induced; D007036:Hypothermia, Induced; D010477:Perfusion / Q000379:methods; D014683:Vena Cava, Superior