Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure

• Published in: Critical care explorations 2024-05, Vol.6 (5), p.e1083-e1083
• Main Authors: Jijeh, Abdulraouf M Z, Fatima, Anis, Faraji, Mohammad A, Hamadah, Hussam K, Shaath, Ghassan A
• Format: Article
• Language: English
• Subjects: Cerebrovascular Circulation - physiology; Cohort Studies; Female; Fontan Procedure; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Hemodynamics - physiology; Humans; Infant; Intracranial Pressure - physiology; Male; Original Clinical Report; Prospective Studies; Ultrasonography, Doppler, Transcranial - methods; Vena Cava, Superior - diagnostic imaging; Vena Cava, Superior - physiopathology
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000001083

This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP. A single-center prospective cohort study. The study was conducted in a cardiac center over 4 years (2019-2022). Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded. Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24-48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured. TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10-16 mm Hg) to 15 mm Hg (IQR, 12-21 mm Hg) postoperatively ( = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14-30 mm Hg) to 28 mm Hg (IQR, 22-38 mm Hg) postoperatively ( = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar. Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.