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Ann Thorac Surg 2006;82:323-325
© 2006 The Society of Thoracic Surgeons

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Case report

Detection of Lower Torso Ischemia by Near-Infrared Spectroscopy During Cardiopulmonary Bypass in a 6.8-Kg Infant With Complex Aortic Anatomy

^a Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany
^b Department of Perfusion, Deutsches Herzzentrum Berlin, Germany
^c Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany
^d Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
^e Institute of Physiology, Charité-Universitätsmedizin, Berlin, Germany

Accepted for publication September 1, 2005.

^_* Address correspondence to Dr Koster, Department of Anesthesia, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin (Email: koster{at}dhzb.de).

Neonates and small infants with congenital heart disease and complex cardiac and vascular anatomy are particularly prone to episodes of complete or incomplete regional ischemia during cardiopulmonary bypass. These episodes may result either from inhomogeneous distribution of arterial blood flow via the aortic cannula or from impaired drainage of blood via the venous cannulae. However, techniques for continuous routine monitoring of regional perfusion in neonates or small infants undergoing cardiopulmonary bypass are extremely limited. Over recent years, transcranial near-infrared spectroscopy has become established as a useful technique for the non-invasive monitoring of cerebral oxygenation. Here we present a case in which simultaneous near-infrared spectroscopic monitoring of the oxygenation status in the brain and the right upper thigh revealed lower torso ischemia due to accidental cross-clamping of a hypoplastic descending aorta which would otherwise have been unnoticed. This shows that parallel near-infrared spectroscopy of the brain and the lower extremities may represent a novel non-invasive monitoring technique to ensure adequate cerebral and extracerebral perfusion during cardiopulmonary bypass.

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