Cerebral oxygen saturation before congenital heart surgery.
BACKGROUND
In congenital heart disease (CHD), neurologic abnormalities suggestive of hypoxia-ischemia are often apparent before cardiac surgery. To evaluate preoperative cerebral oxygenation, this study determined cerebral O2 saturation (ScO2) in CHD and healthy children.


METHODS
Ninety-one CHD and 19 healthy children aged less than 7 years were studied before surgical or radiologic procedures. Arterial saturation (SaO2) and ScO2 were measured by pulse-oximetry and near infrared cerebral oximetry. Cerebral O2 extraction (CEO2) was calculated (SaO2-ScO2). SaO2, ScO2, and CEO2 were compared among diagnoses. Multivariable regression was performed between ScO2 and clinical variables.


RESULTS
In healthy subjects, ScO2 (68%+/-10%) and CEO2 (30%+/-11%) were similar to patients with ventricular septal defect, aortic coarctation, and single ventricle after Fontan operation. ScO2 was significantly decreased in patients with patent ductus arteriosus (53%+/-8%), tetralogy of Fallot (57%+/-12%), hypoplastic left heart syndrome (46%+/-8%), pulmonary atresia (38%+/-6%), and single ventricle after aortopulmonary shunt (50%+/-7%), or bidirectional Glenn operation (43%+/-6%). CEO2 was significantly different only in patent ductus arteriosus (46%+/-8%) and hypoplastic left heart syndrome (38%+/-12%). In multivariable regression, only SaO2 was related to ScO2 (R = 0.63, p < 0.001).


CONCLUSIONS
Cerebral oxygenation in CHD varies with anatomy and arterial saturation, and in some patients, it is very low compared with healthy subjects.
Kurth
C D
CD
Department of Anesthesiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA. kurth@email.chop.edu
Steven
J L
JL
Montenegro
L M
LM
Watzman
H M
HM
Gaynor
J W
JW
Spray
T L
TL
Nicolson
S C
SC
D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis*; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D002534:Hypoxia, Brain / Q000097:blood / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D019265:Spectroscopy, Near-Infrared
D010100:Oxygen