An evaluation of brain blood flow with the single cerebral perfusion method during aortic arch aneurysm graft replacement

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1. ControlDuring 10 open heart surgeries in adults, blood flow velocity in the ophthalmic crtery (OAV) and common carotid artery (CAV) were measured with Doppler ultrasonography, and blood flow volume in the brachiocephalic artery (BA flow) was measured simultaneously with an electromagnetic flow meter. When CPB pump flow was varied, OAVmax more accurately reflected changes in pump flow than did CAVmax and BA flow. Because vessel resistance in the OA was small during CPB,OAVmax was thought to be determined by pump flow of CPB.OAVmax was useful for monitoring brain blood flow during CPB.2. Single cerbral perfusion (SCP) in cases of aortic arch aneurysmDuring two surgical repairs of aortic arch aneurysms, OAVmax before CPB was 0.19m/sec on right side and 0.23m/sec on left side, and that before SCP was 0.09m/sec and 0.10m/sec respectively. During SCP,OAVmax was 0.07m/sec at the perfusion site (right) and 0.06m/sec at the nonperfusion site (left) at perfusion flow rates of 600 to 700ml/min. Changes in OAVmax at the start of CPB,before SCP,during SCP,after SCP,and after CPB were 73.7%, 47.4%, 36.8%, 121.1%, and 231.6% at the perfusion site and 82.6%, 43.5%, 26.1%, 152.2%, and 217.4% at the nonperfusion site. Oxidation levels of cytochrome and hemoglobin were nearly constant during measurements of brain tissue oxygenation. Oxygen saturation in the jugular vein was normal. Levels of lactic acid and pyruvic acid increased, but there were no differences between the right and left sides. Measurement of OAV at both the perfusion and nonperfusion sites is useful for monitoring brain blood flow during SCP.The safety of SCP was also confirmed.