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Ann Thorac Surg 2001;71:673-677
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Clinical implication of orbital ultrasound monitoring during selective cerebral perfusion

Kazumasa Orihashi, MDa, Yuichiro Matsuura, MDa, Taijiro Sueda, MDa, Hiroo Shikata, MDa, Masanobu Watari, MDa, Kenji Okada, MDa

a First Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan

Accepted for publication May 12, 2000.

Address reprint requests to Dr Orihashi, First Department of Surgery, Hiroshima University School of Medicine, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
e-mail: ka-ori{at}mcai.med.hiroshima-u.ac.jp

Background. We evaluated clinical relevance of orbital ultrasound (OUS) monitoring to neurological events in aortic surgery associated with selective cerebral perfusion (SCP).

Methods. In 24 consecutive cases, blood flow was monitored at central retinal artery (CRA) and retrobulbar vessels. The threshold perfusion pressure for detecting CRA flow in the color Doppler mode (BPt) was determined in individual eyes.

Results. The BPt ranged from 25 to 71 mm Hg. Events (infarction, anisocoria, delirium) occurred in 8 cases. Infarction occurred in all 3 cases when retrobulbar flow was severely impaired for 40 minutes or longer, while none of the remaining 21 cases had infarction (p = 0.0005). Among the latter cases, perfusion pressure was below BPt for longer than 100 minutes in all 5 cases with events, and in 5 of 16 cases without events (p = 0.0124). No significant difference was found in age, duration of cardiopulmonary bypass, SCP, and circulatory arrest, and duration of blood pressure below 50 mm Hg.

Conclusions. Sustained hypoperfusion detected with OUS monitoring is related to an occurrence of neurological events.




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