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Transcranial Doppler-revealed retrograde cerebral artery flow during Norwood 1 operation. 2006

Stephen J Kimatian, and John L Myers, and Samuel K Johnson, and Pertti K Suominen
Department of Anesthesiology, Penn State Children's Hospital, Penn State College of Medicine, Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA.

We describe a 6-week-old girl with a hypoplastic left heart syndrome in whom multimodal neuromonitoring was used during Norwood stage I palliation. After placement of modified Blalock-Taussig shunt, transcranial Doppler measurements revealed retrograde flow in the right middle cerebral artery throughout the cardiac cycle. Further examination showed that the change in cerebral blood flow was secondary to shunt runoff and clinical correlation was noted in near infrared spectroscopy measurements of regional cerebral oxygenation saturation. The surgical procedure was subsequently modified with a return of antegrade flow. We offer this case as one of the first (if not the first) documented case reports of an intraoperative modification of surgical procedure driven by changes identified by multimodal neuromonitoring.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D005260 Female Females
D006348 Cardiac Surgical Procedures Surgery performed on the heart. Cardiac Surgical Procedure,Heart Surgical Procedure,Heart Surgical Procedures,Procedure, Cardiac Surgical,Procedure, Heart Surgical,Procedures, Cardiac Surgical,Procedures, Heart Surgical,Surgical Procedure, Cardiac,Surgical Procedure, Heart,Surgical Procedures, Cardiac,Surgical Procedures, Heart
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016343 Monitoring, Intraoperative The constant checking on the state or condition of a patient during the course of a surgical operation (e.g., checking of vital signs). Intraoperative Monitoring
D017585 Ultrasonography, Doppler, Transcranial A non-invasive technique using ultrasound for the measurement of cerebrovascular hemodynamics, particularly cerebral blood flow velocity and cerebral collateral flow. With a high-intensity, low-frequency pulse probe, the intracranial arteries may be studied transtemporally, transorbitally, or from below the foramen magnum. Doppler Sonography, Transcranial,Doppler Transcranial Sonography,Doppler Transcranial Ultrasonography,Doppler Ultrasonography, Transcranial,Sonography, Transcranial Doppler,Ultrasonography, Transcranial Doppler,Neurosonology,Sonography, Doppler Transcranial,Transcranial Doppler Sonography,Transcranial Doppler Ultrasonography,Transcranial Sonography, Doppler,Transcranial Ultrasonography, Doppler,Ultrasonography, Doppler Transcranial,Neurosonologies
D018636 Hypoplastic Left Heart Syndrome A condition caused by underdevelopment of the whole left half of the heart. It is characterized by hypoplasia of the left cardiac chambers (HEART ATRIUM; HEART VENTRICLE), the AORTA, the AORTIC VALVE, and the MITRAL VALVE. Severe symptoms appear in early infancy when DUCTUS ARTERIOSUS closes. Left Heart Syndrome, Hypoplastic,Left Heart Hypoplasia Syndrome
D020768 Middle Cerebral Artery The largest of the cerebral arteries. It trifurcates into temporal, frontal, and parietal branches supplying blood to most of the parenchyma of these lobes in the CEREBRAL CORTEX. These are the areas involved in motor, sensory, and speech activities. Cerebral Artery, Middle,Arteries, Middle Cerebral,Artery, Middle Cerebral,Cerebral Arteries, Middle,Middle Cerebral Arteries

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