Recent advancements in ultrasound imaging have opened up new possibilities for assessing cerebrovascular autoregulation in human neonates. Newborns with congenital heart diseases undergoing cardiopulmonary bypass are at risk of neurodevelopmental impairment, and understanding the impact of this procedure on cerebrovascular autoregulation is crucial. Ultrafast power Doppler imaging has shown promise in studying cerebrovascular autoregulation based on cerebral blood volume in neonates. However, accurately monitoring brain perfusion variation based on cerebral blood volume requires discriminating between arterial and venous compartments.
A study aimed to use ultrafast power Doppler combined with an algorithm for discriminating arteries and veins to monitor cerebrovascular autoregulation during deep hypothermic cardiopulmonary bypass (DH-CPB) in neonates. The study included two groups: those undergoing DH-CPB and those undergoing full-flow CPB at mild hypothermia. By differentiating arterial compartments from venous compartments using blood flow directionality, the study aimed to analyze the association between arterial cerebral blood volume and mean arterial blood pressure.
In the group undergoing CPB at mild hypothermia, a negative association was found between arterial cerebral blood volume and mean arterial blood pressure, indicating active arterial vasoconstriction triggered by cerebrovascular autoregulation. Conversely, in the group undergoing DH-CPB, no significant association was found, suggesting impaired cerebrovascular autoregulation response. The study also observed significant differences in venous cerebral blood volume changes in relation to mean arterial blood pressure during DH-CPB, indicating an altered autoregulatory response.
Furthermore, the study found regional variations in cerebrovascular autoregulation response, with differences between cortico-subcortical areas and basal ganglia. The observed variations highlight the region-specific nature of cerebrovascular autoregulation, with potential implications for brain injury and neurodevelopmental outcomes in neonates with congenital heart diseases.
These findings underscore the importance of temperature management during cardiopulmonary bypass procedures to preserve cerebrovascular autoregulation and maintain stable hemodynamics in neonates. The study opens up avenues for further research using ultrafast ultrasound imaging to continuously monitor cerebrovascular autoregulation and optimize neurovascular management strategies in this vulnerable patient population.
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