title: Esophageal saturation during antegrade cerebral perfusion: a preliminary report using visible light spectroscopy.
abstract: BACKGROUND
  Visible light spectroscopy (VLS) is newer technology that measures real-time tissue oxygenation. It has been validated in detecting mucosal ischemia in adults. During complex neonatal heart surgery, antegrade cerebral perfusion (ACP) maintains cerebral saturation. Whether ACP maintains peripheral tissue perfusion in humans is not known.
  
  
  METHODS
  Five patients undergoing neonatal open heart surgery with hypothermic cardiopulmonary bypass (CPB) were studied using a VLS esophageal probe in addition to bilateral near infrared cerebral oximetry. Three of five patients required ACP for arch repair, while two patients did not. VLS and cerebral saturation data were collected and analyzed in 5 min intervals prior to CPB, during CPB, and during ACP.
  
  
  RESULTS
  In the two patients undergoing heart surgery with routine hypothermic CPB, both cerebral and esophageal saturations were maintained. However in all three neonates requiring ACP, although cerebral saturations did not decrease, esophageal saturation fell below the ischemic threshold (35%). Following establishment of normal CPB, esophageal saturation returned to baseline.
  
  
  CONCLUSIONS
  Antegrade cerebral perfusion maintains cerebral oxygen delivery, however, it does not adequately perfuse the esophagus in neonates. This could have clinical implications.
authors.affiliation: Stanford School of Medicine, Stanford, CA 94305, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Heninger
authors.forename: Chandra
authors.initials: C
authors.lastname: Ramamoorthy
authors.forename: Gabriel
authors.initials: G
authors.lastname: Amir
authors.forename: Komal
authors.initials: K
authors.lastname: Kamra
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.forename: John G
authors.initials: JG
authors.lastname: Brock-Utne
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D004947:Esophagus / Q000098:blood supply*; D006801:Humans; D007036:Hypothermia, Induced; D007231:Infant, Newborn; D007511:Ischemia / Q000175:diagnosis; D008027:Light; D016343:Monitoring, Intraoperative; D010092:Oximetry / Q000295:instrumentation*; D010100:Oxygen / Q000378:metabolism*; D013057:Spectrum Analysis / Q000295:instrumentation*
chemical_list: D010100:Oxygen