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J Thorac Cardiovasc Surg 1998;115:94-98
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Measurement of cerebral blood flow during cardiopulmonary bypass with near-infrared spectroscopy

Departments of Neurosciences^a and Cardiothoracic Surgery,^b Institute of Child Health (UCL) and Great Ormond Street Hospital forChildren, Department of Paediatrics and Neonatal Medicine, Royal PostgraduateMedical School,^c Department of Medical Physics and Bioengineering,University College London, London, United Kingdom, ^d and Departmentof Surgery Duke University Medical Center, Durham, N.C.^e C.E.C.is a Medical Research Council Training Fellow. This work was funded by theBritish Heart Foundation.

Received for publication June 23, 1997; revisions requested August12, 1997; revisions received Sept. 15, 1997; accepted for publication Sept.15, 1997. Address for reprints: Idris Roberts, BSc, Biomedical EngineeringDepartment, Great Ormond Street Hospital for Children, Great Ormond Street,London WC1 3JH, United Kingdom.

Objective: A novel noninvasive methodfor repeatedly measuring cerebral blood flow during cardiopulmonary bypassby near-infrared spectroscopy is described. The reproducibility of the methodis investigated and a comparison is made with an established technique.
Methods and results: The method is derived from theFick principle and uses indocyanine green dye, injected into the bypass circuit,as an intravascular tracer. Cerebral blood flow was measured in nine childrenundergoing cardiopulmonary bypass on a total of 49 occasions. Results fromthis study suggest that an integrating period of 4 seconds provided a consistentmeasurement of global cerebral blood flow. The values obtained ranged from3.2 to 32.4 (median 15.9) ml 100 gm^–1 min^–1. In an additional 10 children in whom repeated measurementswere made, the coefficient of variation was 11% ± 7% (mean ±standard deviation). In a further study, the method was compared with microsphereinjection in five piglets undergoing cardiopulmonary bypass. The comparisonwithin each animal with the linear least squares method gave values for R² in the range 0.91 to 0.99. The gradientsof the fits ranged from 0.5 to 1.8 (median 1.0). The mean difference betweenthe two techniques was 5.7 ml 100 gm^–1 min^–1 or 7%. The coefficient of variation for the piglets was 14%± 9% (mean ± standard deviation).
Conclusions: Indocyanine green and near-infrared spectroscopy allowfrequent and repeated measurements of cerebral blood flow during cardiopulmonarybypass. The measurements are reproducible and accurately reflect changes incerebral blood flow. It may be widely applicable both in research and clinicalpractice.

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