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Color Doppler imaging of the retinal vessels during repair of aortic dissection

1999; Elsevier BV; Volume: 13; Issue: 6 Linguagem: Inglês

10.1016/s1053-0770(99)90127-1

1532-8422

Paolo Voci, Antonio Menichetti, Luigi Tritapepe, Alessandra Rossi, Quintilio Caretta,

Cardiac and Coronary Surgery Techniques

C EREBRAL HYPOPERFUSION during cardiovascular surgery represents a significant burden and may produce physical deficits, psychologic deficits, or both. 1 Perioperative neurologic damage may be caused by intraoperative embolism, deep hypothermic circulatory arrest, nonpulsatile flow of extracorporeal circulation, unrecognized carotid artery stenosis, or transient occlusion of a carotid artery by the infimal flap during repair of dissection. Transcranial Doppler can be used to measure cerebral blood flow during cardiac surgery, but this technique is not feasible in all patients, particularly in the elderly because of the increased thickness of the temporal bone, which attenuates the Doppler beam. Other methods to monitor cerebral blood flow and neuron metabolism, such as electroencephalography, evoked potentials, carotid echography, transcranial Doppler, fluorescein angiography, and study of biochemical markers of neuronal and glial damage, have yielded inconclusive results. High-resolution color Doppler imaging allows visualization of the central retinal artery and measurement of its blood flow velocity, 2,3 which reflects internal carotid artery flow. Orihashi et al 4 described central retinal artery and mtrobulbar vessel flow during coronary artery bypass grafting, valvular replacement, and aortic surgery. The authors describe more extensive imaging of the retinal vessels, including peripheral intrabulbar branches, during retrograde cerebral perfusion for repair of aortic dissection and discuss the potential impact of this technique in cardiac surgery.