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J Thorac Cardiovasc Surg 1998;116:503-507
© 1998 Mosby, Inc.

Cardiopulmonary Support and Physiology

Regional cerebral blood flow during rewarming of cardiopulmonary bypass correlates with posthypothermic regional glucose use

From the Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute,^a and the Institute for Biofunctional Research,^b Osaka, Japan.

Received for publication June 4, 1997. Revisions requested August 8, 1997; revisions received Feb. 27, 1998. Accepted for publication Feb. 27, 1998. Address for reprints: Hiroshi Miyano, MD, Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, 5-7-1 Fujishirodai, Suita, Osaka 565, Japan.

Background and objectives: Although global measurements of cerebral blood flow and metabolism during and after profoundly hypothermic cardiopulmonary bypass have been performed both in experimental animals and in human beings, little is known about their regional changes. The purpose of this study was to investigate the changes in regional cerebral blood flow during profoundly hypothermic cardiopulmonary bypass and regional cerebral glucose use after cardiopulmonary bypass.
Methods: We measured regional cerebral blood flow with positron emission tomography during both the cooling (n = 5) and rewarming (n = 5) of hypothermic cardiopulmonary bypass in anesthetized dogs by continuously infusing ¹⁵O-labeled water. We altered the core temperature between 20° and 37° C. To assess the integrity of brain metabolism, we measured the regional cerebral glucose use by bolus injections of ¹⁸F-labeled 2-fluoro-2-deoxy-D-glucose.
Results: Regional cerebral blood flow decreased homogeneously during cooling. The regional cerebral blood flow at 20° C was about one fourth of that at 37° C. In contrast, at 24°, 28°, and 32° C during rewarming, there were significant interregional differences in the regional cerebral blood flow for given temperatures (p = 0.0075, 0.034, and 0.048, respectively). These interregional differences disappeared after rewarming. Although the regional cerebral blood flow significantly correlated with the regional cerebral glucose use in the control condition at 37° C without cardiopulmonary bypass (r = 0.75; p = 0.00012), this correlation disappeared after profoundly hypothermic cardiopulmonary bypass (r = 0.204; p = 0.388). Regional cerebral blood flow at 32° C during rewarming positively correlated with the regional cerebral glucose use after cardiopulmonary bypass (r = 0.655; p = 0.0017).
Conclusion: The altered regional cerebral blood flow during rewarming of profoundly hypothermic cardiopulmonary bypass might affect regional brain metabolism.

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