Selective Cerebral Perfusion Technique During Aortic Arch Repair in Neonates

We describe selective cerebral perfusion techniques for repair of the aortic arch in neonates. These techniques may help protect the brain from ischemic injury caused by a cessation of cerebral perfusion for aortic arch reconstruction in patients with hypoplastic left heart syndrome or interrupted aortic arch.
Although hypothermic circulatory arrest has been a widely used procedure for the surgical repair of
arch anomalies in neonates and infants, it has been suggested that this procedure sometimes produces neurologic injury. Because the long-term outcomes of cerebral function such as intellectual function and development after hypothermic circulatory arrest still remain to be determined, it seems worthwhile to protect the brain from ischemic injury as much as possible in neonatal open heart operations. We herein present some selective cerebral perfusion techniques in which the cerebral blood flow can be better maintained during the reconstruction of the aortic arch in the Norwood operation for neonates with hypoplastic left heart syndrome.
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heart lung machine

Cardiopulmonary bypass ( CPB ) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient's body. The CPB pump itself is often referred to as a heart–lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment.

cardiopulmonary bypass and cardioplegia

Extracorporeal circulation and cardiopulmonary bypass are synonymous terms denoting a method by which the blood that usually returns directly to the heart is temporarily drained from the superior and inferior venae cavae. The blood is diverted into a reservoir, where it is oxygenated and subsequently returned to the patient’s arterial circulation. This process effectually excludes the heart from the general circulation and leaves it empty so that it can accommodate surgical intervention. Myocardial protection To provide a dry, motionless, operative area, a cross-clamp is placed across the ascending aorta above the coronary ostia and proximal to the aortic cannula, thus isolating the coronary circulation and preventing blood entering the chambers of the heart. Therefore, techniques of myocardial protection are used to preserve myocardial function and prevent cell death. Cardioplegic techniques for myocardial protection involve the delivery of cardioplegic solution t...

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