title: Detection of lower torso ischemia by near-infrared spectroscopy during cardiopulmonary bypass in a 6.8-kg infant with complex aortic anatomy.
abstract: Neonates and small infants with congenital heart disease and complex cardiac and vascular anatomy are particularly prone to episodes of complete or incomplete regional ischemia during cardiopulmonary bypass. These episodes may result either from inhomogeneous distribution of arterial blood flow via the aortic cannula or from impaired drainage of blood via the venous cannulae. However, techniques for continuous routine monitoring of regional perfusion in neonates or small infants undergoing cardiopulmonary bypass are extremely limited. Over recent years, transcranial near-infrared spectroscopy has become established as a useful technique for the non-invasive monitoring of cerebral oxygenation. Here we present a case in which simultaneous near-infrared spectroscopic monitoring of the oxygenation status in the brain and the right upper thigh revealed lower torso ischemia due to accidental cross-clamping of a hypoplastic descending aorta which would otherwise have been unnoticed. This shows that parallel near-infrared spectroscopy of the brain and the lower extremities may represent a novel non-invasive monitoring technique to ensure adequate cerebral and extracerebral perfusion during cardiopulmonary bypass.
authors.affiliation: Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Redlin
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Boettcher
authors.forename: Michael
authors.initials: M
authors.lastname: Huebler
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: Wolfgang M
authors.initials: WM
authors.lastname: Kuebler
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery; D001015:Aortic Arch Syndromes / Q000601:surgery; D001020:Aortic Stenosis, Subvalvular / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002560:Cerebrovascular Circulation; D003250:Constriction; D005263:Femoral Artery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D007866:Leg / Q000098:blood supply*; D016343:Monitoring, Intraoperative; D009928:Organ Specificity; D010108:Oxyhemoglobins / Q000032:analysis*; D012086:Reoperation; D019265:Spectroscopy, Near-Infrared; D013848:Thigh; D013927:Thrombosis / Q000150:complications
chemical_list: D010108:Oxyhemoglobins