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J Thorac Cardiovasc Surg 2003;126:186-190
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Sodium nitroprusside infusion after bidirectional superior cavopulmonary connection: preserved cerebral blood flow velocity and systemic oxygenation

^a From the Divisions of Pediatrics,^a Cardiology, Medical University of South Carolina, Charleston, SC, USA
^b Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
^c Division of Radiology,^c Medical University of South Carolina, Charleston, SC, USA

Received for publication September 18, 2002; accepted for publication March 14, 2003.

^* Address for reprints: Janet M. Simsic, MD, Sibley Heart Center Cardiology, 52 Executive Park South, Suite 5200, Atlanta, GA 30329 , USA
simsicj{at}kidsheart.com

OBJECTIVE: Systemic hypertension is common in patients after bidirectional superior cavopulmonary connection. It can be treated with a vasodilator, such as sodium nitroprusside. However, it is possible that systemic hypertension is necessary to maintain cerebral blood flow in the face of cerebral venous hypertension. Furthermore, bidirectional superior cavopulmonary connection places the cerebral and pulmonary vascular beds in series. Thus treatment of systemic hypertension by lowering blood pressure might decrease cerebral blood flow, pulmonary blood flow, and systemic oxygen levels. The aim of the current study was to determine the effects of sodium nitroprusside on cerebral blood flow velocity and systemic oxygenation in patients after bidirectional superior cavopulmonary connection.

METHODS: This is a prospective patient-controlled study of 9 patients (median age, 7 months; age range, 4 to 12 months) undergoing bidirectional superior cavopulmonary connection. Patients were studied in the intensive care unit within 6 hours of surgical intervention while sedated, paralyzed, and mechanically ventilated. Sodium nitroprusside was infused to achieve a decrease in mean systemic blood pressure of approximately 20%. Cerebral blood flow velocity was measured by means of transcranial Doppler ultrasonography of the middle cerebral artery.

RESULTS: During sodium nitroprusside infusion, mean systemic blood pressure decreased (from 69 ± 6 mm Hg at baseline to 58 ± 6 mm Hg, P < .05). However, there was no accompanying change in 2 indicators of cerebral blood flow: blood flow velocity in the middle cerebral artery and arteriovenous oxygen saturation difference across the upper body. Both arterial PO₂ and systemic oxygen saturation were also preserved during sodium nitroprusside infusion.

CONCLUSIONS: Sodium nitroprusside decreases systemic blood pressure in patients after bidirectional superior cavopulmonary connection. This decrease occurs without accompanying changes in cerebral blood flow velocity or systemic oxygen levels. These findings suggest that cerebral and pulmonary blood flows are preserved during sodium nitroprusside infusion. Sodium nitroprusside appears to be an appropriate agent for the treatment of systemic hypertension after bidirectional superior cavopulmonary connection.