Cerebral Blood Flow Velocity During Occlusive Manipulation of Patent Ductus Arteriosus in Children

Abstract

Patent ductus arteriosus (PDA) with left-to-right shunting modifies the Doppler flow pattern of the intracranial circulation. The ability of increases in cerebral blood flow velocity (CBFV) to predict shunt resolution during PDA occlusion was evaluated. A 2 MHz transcranial Doppler (TCD) monitored diastolic and mean CBFV, plus the systolic/mean CBFV ratio in the middle cerebral artery from before (baseline) to immediately after PDA occlusion. Shunt resolution was verified by echocardiography and/or angiography. A minimum of 40% increase in diastolic-CBFV from baseline was considered successful resolution. Patients were age-stratified into group I (< 15 months; n = 23) and group II (> 15 months; n = 10). Thirty-three children were studied (age, 0.1 to 109 months) during surgical (n = 22) or coil occlusions (n = 11). Transcranial Doppler successfully identified shunt resolution in 78% of cases in group I, as compared to 0% in group II (p < 0.01). Identification rate decreased from 79% in cases of minimum ductal diameter of 3 mm (n = 19) to 21% in smaller ductuses (n = 14) (p < 0.01). Body weight and left-atrium size (p = 0.004) in group I and PDA diameter in group II (p = 0.02), were the only preoperative ductal parameters associated with diastolic-CBFV changes after ductus occlusion. Transcranial Doppler detects shunt resolution in infants with moderate to large PDAs.

Instant Detection of Cerebral Blood Flow Changes in Infants with Congenital Heart Disease during Transcatheter Interventions

“…This is exemplified with the two inclusions with PDA where there is an increase in EDV and reduced pulsatility after intervention. This has previously been shown with transcranial Doppler in infants during transcatheter intervention and in surgical ligations of PDA [10,11,15,16]. In this material, there was one patient with a complication in the form of embolization of the ductus device after the initial occlusion.…”

“…Transcranial Doppler devices have been utilized in studies involving children with CHD but are not used regularly in the clinical setting [ 8 , 9 , 10 , 11 ]. Furthermore, the attachment mechanisms that these devices employ are not appropriate for infants.…”

“…Transcranial Doppler can be used to monitor cerebral blood flow velocities (CBFVs) during transcatheter interventions and has shown clinically significant changes in brain perfusion during certain procedures [ 8 , 9 , 10 , 11 ]. However, these studies are now more than two decades old and cardiac interventions have evolved considerably since then.…”

Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): Ligation of PDA on CPB can compromise cerebral blood flow

“…Earlier, Rodriguez et al, had described an increase in the cerebral blood flow velocity by more than 40% in children less than 15 months old, on surgical or coil occlusion of PDA. [7] Increase in the BIS score with an increase in cerebral perfusion was reported earlier. [8] The close relationship between changes in entropy and ABP, with initiation of CPB, and ligation of PDA indicate that the decrease in entropy was secondary to a decrease of cerebral perfusion, due to arterial inflow steal in the pulmonary circulation; and the increase in entropy after PDA ligation was secondary to the increase / restoration of cerebral perfusion.…”

Relative Blood Flow Changes Measured Using Calibrated Frequency-Weighted Doppler Power at Different Hematocrit Levels

“…Proximal vessels have limited vasodilation capabilities compared to more distal cerebral arterioles, and therefore reduced CBFV in the proximal vessels is more likely to represent reduced blood volume flow (6). Furthermore, a reduction in diastolic BFV, secondary to diastolic steal reducing volume flow, in proximal vessels is described in neonates and infants with patent ductus arteriosus (13).…”