Cerebral blood flow dynamics during cardiac surgery in infants
Open accessAbstract
BACKGROUND: In this pilot study, we investigated continuous cerebral blood flow velocity measurements to explore cerebrovascular hemodynamics in infants with congenital heart disease undergoing cardiac surgery. METHODS: A non-invasive transfontanellar cerebral Doppler monitor (NeoDoppler) was used to monitor 15 infants (aged eight days to nine months) during cardiac surgery with cardiopulmonary bypass. Numerical and visual analyses were conducted to assess trends and events in Doppler measurements together with standard monitoring equipment. The mean flow index, calculated as the moving Pearson correlation between mean arterial pressure and time averaged velocity, was utilized to evaluate dynamic autoregulation. Two levels of impaired autoregulation were defined (Mean flow index >0.3/0.45), and percentage of time above these limits were calculated. RESULTS: High quality recordings were achieved during 90.6% of the monitoring period. There was a significant reduction in time averaged velocity in all periods of cardiopulmonary bypass. All patients showed a high percentage of time with impaired dynamic autoregulation, with Mean flow index >0.3 and 0.45: 73.71% ± 9.06% and 65.16% ± 11.27% respectively. Additionally, the system promptly detected hemodynamic events. CONCLUSION: Continuous transfontanellar cerebral Doppler monitoring could become an additional tool in enhancing cerebral monitoring in infants during cardiac surgery. IMPACT: This pilot study demonstrates the feasibility of continuous transfontanellar Doppler monitoring of cerebral blood flow velocities during cardiac surgery in infants. It also demonstrates a high proportion of time with impaired cerebral autoregulation during cardiac surgery based on the Mean flow index. Continuous transfontanellar Doppler could become a useful tool to improve cerebral monitoring and provide new pathophysiological insight.
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Clinicians can assess cerebral autoregulatory function in relation to systemic blood pressure by measurement of cerebral blood flow velocities along with mean arterial pressure and near-infrared spectroscopy.
“Clinicians can assess cerebral autoregulatory function in relation to systemic blood pressure by measurement of cerebral blood flow velocities (CBFVs) along with mean arterial pressure and near-infrared spectroscopy (NIRS) [62].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [62]
The Introduction says autoregulation can be described using mean arterial pressure with either Doppler-measured cerebral blood flow velocity or NIRS. The claim instead presents all three measurements as a combined approach; the Discussion also distinguishes this study’s Doppler-based assessment from studies using MAP and NIRS. Our copy provides no page numbers for these passages. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMore recently, the same group demonstrated that NeoDoppler could continuously track CBFV fluctuations throughout cardiopulmonary bypass in infants undergoing various cardiac surgical procedures, and that it could detect hemodynamic changes more rapidly than NIRS.
“More recently, the same group demonstrated that NeoDoppler could continuously track CBFV fluctuations throughout cardiopulmonary bypass in infants undergoing various cardiac surgical procedures, and that it could detect hemodynamic changes more rapidly than NIRS [62].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [62]
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- Authors
- Leth-Olsen, M., Døhlen, G., Torp, H., & Nyrnes, S. A.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Oslo University Hospital (NO)
- Corresponding author
- Leth-Olsen, Martin
- Venue
- Pediatric Research
- Published
- 2024-04-03
- Volume
- 97
- Issue
- 2
- Pages
- 625-633
- ISSN
- 0031-3998 (ISSN-L)
- 1530-0447
- PMC
- PMC12014472
- OpenAlex
- W4393898768
- Cited by
- 12
- References
- 38
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 4
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Pediatric Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Norges Forskningsråd (260699/O30)
- St. Olavs Hospital Universitetssykehuset i Trondheim
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- cerebral blood flow velocity, cerebral autoregulation, infants, congenital heart disease, cardiac surgery, cardiopulmonary bypass, cerebral hemodynamics, hemodynamic monitoring
- MeSH terms
- Blood Flow Velocity, Cardiopulmonary Bypass, Cerebrovascular Circulation, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Hemodynamics, Homeostasis, Humans, Infant, Infant, Newborn, Male, Pilot Projects, Monitoring, Intraoperative, Ultrasonography, Doppler, Transcranial
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