OBJECTIVES Aortic coarctation with distal aortic arch hypoplasia can be effectively addressed by coarctation resection with extended end-to-end-anastomosis (REEEA). Particularly, when unilateral cerebral perfusion (UCP) is established by clamping of left-sided supra-aortic vessels, the extent of cerebral blood flow distribution during repair remains undetermined, so far. Transfontanellar contrast-enhanced ultrasound (T-CEUS) can be utilized for real-time visualization and quantitative evaluation of cerebral blood flow. This study quantitatively evaluates cerebral perfusion during REEEA by using intraoperative T-CEUS. METHODS In a prospective study, 9 infants with open fontanelle undergoing REEEA [median age: 13 days (range 1–34) and median weight 3.1 kg (range 2.2–4.4)] were intraoperatively examined with T-CEUS at 3 consecutive time-points: before skin incision, during UCP and after skin suture. A software-based analysis of 11 parameters was used for data evaluation. Absolute and relative blood flow in contralateral hemispheres was measured in side-by-side comparison, and referenced to baseline measurements. RESULTS No side-depend absolute or relative cerebral perfusion differences were found during REEEA, except for an increased relative ‘wash-out-rate’ (P = 0.0013) in favour of the right hemisphere after surgery. Compared to ipsilateral baseline levels, ‘rise time’ was transiently increased in right (P = 0.0277) and ‘time-to-peak’ in both hemispheres (right: P = 0.0403 and left: P = 0.0286), all during UCP. CONCLUSIONS The use of T-CEUS provided evidence for homogenous distribution of contrast agent in both hemispheres during UCP. T-CEUS can be utilized for the postprocedural evaluation of cerebral perfusion during congenital cardiac surgery. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique, Identifier: NCT03215628.

中文翻译：

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扩大主动脉缩窄修复过程中的平等脑灌注

目的 主动脉缩窄伴远端主动脉弓发育不全可通过扩大端对端吻合术 (REEEA) 的缩窄切除术得到有效解决。特别是，当通过夹住左侧主动脉上血管建立单侧脑灌注（UCP）时，修复过程中脑血流分布的程度至今仍未确定。经囟门对比增强超声 (T-CEUS) 可用于脑血流的实时可视化和定量评估。本研究使用术中 T-CEUS 定量评估 REEEA 期间的脑灌注。方法 在一项前瞻性研究中，9 名接受 REEEA 的开放囟门婴儿 [中位年龄：13 天（范围 1-34），中位体重 3.1 kg（范围 2.2-4.4）] 在术中连续 3 个时间点用 T-CEUS 检查。 ：皮肤切口前、UCP 期间和皮肤缝合后。11 个参数的基于软件的分析用于数据评估。在并排比较中测量对侧半球的绝对和相对血流量，并参考基线测量值。结果 REEEA 期间没有发现侧依赖的绝对或相对脑灌注差异，除了增加的相对“洗出率”（P = 0.0013）有利于手术后的右半球。与同侧基线水平相比，右半球的“上升时间”（P = 0.0277）和两个半球的“峰值时间”（右：P = 0.0403 和左：P = 0.0286）均在 UCP 期间短暂增加。结论 T-CEUS 的使用为 UCP 期间造影剂在两个半球的均匀分布提供了证据。T-CEUS 可用于先天性心脏手术期间脑灌注的术后评估。临床试验注册 URL：http://www.clinicaltrials.gov 唯一，标识符：NCT03215628。