title: Evaluation of cerebral oxygenation and perfusion with conversion from an arterial-to-systemic shunt circulation to the bidirectional Glenn circulation in patients with univentricular cardiac abnormalities.
abstract: OBJECTIVE
  Superior vena cava pressure after the bidirectional Glenn operation usually is higher than that associated with the preceding shunt-dependent circulation. The aim of the present study was to determine whether the acute elevation in central venous pressure was associated with changes in cerebral oxygenation and perfusion.
  
  
  METHODS
  Single-center prospective, observational cohort study.
  
  
  METHODS
  Academic children's hospital.
  
  
  METHODS
  Infants with single-ventricle lesions and surgically placed systemic-to-pulmonary artery shunts undergoing the bidirectional Glenn operation.
  
  
  METHODS
  Near-infrared spectroscopy and transcranial Doppler sonography were used to measure regional cerebral oxygen saturation and cerebral blood flow velocity.
  
  
  RESULTS
  Mean differences in regional cerebral oxygen saturation and cerebral blood flow velocity before anesthetic induction and shortly before hospital discharge were compared using the F-test in repeated measures analysis of variance. In the 24 infants studied, mean cerebral oxygen saturation increased from 49%±2% to 57%±2% (p = 0.007), mean cerebral blood flow velocity decreased from 57±4 cm/s to 47±4 cm/s (p = 0.026), and peak systolic cerebral blood flow velocity decreased from 111±6 cm/s to 99±6 cm/s (p = 0.046) after the bidirectional Glenn operation. Mean central venous pressure was 8±2 mmHg postinduction of anesthesia and 14±4 mmHg on the first postoperative day and was not associated with a change in cerebral perfusion pressure (p = 0.35).
  
  
  CONCLUSIONS
  The bidirectional Glenn operation in infants with a shunt-dependent circulation is associated with an improvement in cerebral oxygenation, and the lower cerebral blood flow velocity is likely a response of intact cerebral autoregulation.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA. Electronic address: gianluca.bertolizio@mcgill.ca.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bertolizio
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA.
authors.forename: James A
authors.initials: JA
authors.lastname: DiNardo
authors.affiliation: Department of Cardiology, Perioperative and Pain Medicine, Boston, MA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.affiliation: Department of Cardiology, Perioperative and Pain Medicine, Boston, MA.
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.affiliation: Cardiac Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Kussman
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods / Q000592:standards*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D005260:Female; D018729:Fontan Procedure / Q000379:methods / Q000592:standards*; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies
keywords: bidirectional Glenn shunt; congenital heart defect; hypoplastic left-heart syndrome; modified Blalock-Taussig shunt; near-infrared spectroscopy; single ventricle; transcranial Doppler sonography