Leth-Olsen Martin, Døhlen Gaute, Torp Hans, Nyrnes Siri Ann
Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway.
Children's Clinic, St Olav's University Hospital, 7030 Trondheim, Norway.
J Clin Med. 2024 May 26;13(11):3115. doi: 10.3390/jcm13113115.
: Transcatheter interventions are increasingly used in children with congenital heart disease. However, these interventions can affect cardiac output and cerebral circulation. In this pilot study, we aimed to investigate the use of NeoDoppler, a continuous transfontanellar cerebral Doppler monitoring system, to evaluate the impact of transcatheter interventions on cerebral circulation. : Nineteen participants under one year of age (mean age 3.5 months) undergoing transcatheter cardiac interventions were prospectively included. Transfontanellar cerebral Doppler monitoring with the NeoDoppler system was initiated after intubation and continued until the end of the procedure. : Instant detection of changes in cerebral blood flow were observed across a spectrum of transcatheter interventions. Balloon aortic valvuloplasty demonstrated temporary cessation of cerebral blood flow during balloon inflation. Increase in cerebral diastolic blood flow velocity and decreased pulsatility were observed during patent ductus arteriosus occlusion. Changes in cerebral blood flow patterns were detected in two patients who encountered complications during their transcatheter interventions. There was no significant change in Doppler parameters before and after the interventions for the entire patient group. High quality recordings were achieved in 87.3% of the monitoring period. : Continuous transfontanellar cerebral Doppler is feasible in monitoring cerebral hemodynamic trends and shows instantaneous changes associated with interventions and complications. It could become a useful monitoring tool during transcatheter interventions in infants.
经导管介入治疗在先天性心脏病患儿中应用越来越广泛。然而，这些介入治疗会影响心输出量和脑循环。在这项初步研究中，我们旨在探讨使用NeoDoppler（一种经囟门连续脑多普勒监测系统）来评估经导管介入治疗对脑循环的影响。
前瞻性纳入了19名年龄小于1岁（平均年龄3.5个月）接受经导管心脏介入治疗的参与者。在插管后开始使用NeoDoppler系统进行经囟门脑多普勒监测，并持续至手术结束。
在一系列经导管介入治疗中均观察到脑血流变化的即时检测。球囊主动脉瓣成形术显示在球囊充气时脑血流暂时停止。在动脉导管未闭封堵期间观察到脑舒张期血流速度增加和搏动性降低。在两名经导管介入治疗期间出现并发症的患者中检测到脑血流模式的变化。整个患者组在介入治疗前后多普勒参数无显著变化。在87.3%的监测期内获得了高质量的记录。
经囟门连续脑多普勒监测在监测脑血流动力学趋势方面是可行的，并显示出与介入治疗和并发症相关的即时变化。它可能成为婴儿经导管介入治疗期间有用的监测工具。
