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Ann Thorac Surg 1995;60:327-328
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 319.

DR EUGÈNE M. BAUDET (Bordeaux, France): I compliment Dr Boeckxstaens for this very elegant presentation, but I also remind you of two recent articles, one by Okamoto in The Annals and the other by Usui in The Journal of Thoracic and Cardiovascular Surgery, that emphasized some concerns that functioning venous valves in the superior vena cava system, and especially at the jugular–subclavian junction, could impede retrograde flow to the brain with consequent inadequate cerebral perfusion and protection. Both of these authors referred to an anatomic study done at Bordeaux University by an associate of mine, anatomist Dominique Midy, and published in 1988 in the Bulletin of the French Anatomists Association. In 200 internal jugular vein anatomic dissections, Midy and colleagues found that there was no valvular system in only 12% of cases. Of the 88% in which venous valves in the internal jugular vein were present at the venous angle or jugular-subclavian junction, 68% had a double-valve, 14% a single-valve, and 6% a triple-valve system. Most of these valves are vestigial and incompetent, but in 10% to 20%, they are functioning and could interfere with retrograde flow through the superior vena cava to the brain. These venous valves can be easily identified before operation by internal jugular vein echography in perpendicular as well as sagittal views.

My questions are whether or not you think that these venous valves could favor the shunt into the lower body through the azygos and other communicating veins, and whether or not selective jugular cannulation beyond the valves, as advocated by Okamoto, could overcome this problem or improve cerebral perfusion.

DR BOECKXSTAENS: Thank you for your comment, Dr Baudet. We were aware of that publication, the findings of which were confirmed in a study in the American Journal of Surgery by . . . [Full Text of this Article]

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Retrograde Cerebral Perfusion Does Not Perfuse the Brain in Nonhuman Primates

Christiane J. Boeckxstaens and Willem J. Flameng
Ann. Thorac. Surg. 1995 60: 319-327. [Abstract] [Full Text]

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