# Macro- and microcirculation characteristics in the territory of the anterior cerebral artery in infants with congenital heart diseases

## TL;DR

This study examines how cerebral macro- and microcirculation differ in infants with congenital heart diseases after surgery, compared to those undergoing other procedures.

## Contribution

The study introduces a novel approach to assess both cerebral macro- and microcirculation in infants post-cardiac surgery.

## Key findings

- Systolic peak flow was significantly lower in staged palliation groups compared to others.
- Pulsatility index was higher in aortopulmonary shunt patients compared to other groups.
- Cerebral blood flow was lower in staged palliation groups compared to non-cardiac surgery groups.

## Abstract

Although cerebral macrocirculation is routinely assessed postoperatively in infants in the pediatric intensive care unit, monitoring cerebral microcirculation is not yet a standard practice. Our objective was to investigate the correlation between parameters of cerebral macro- and microcirculation in children following cardiac surgery and compare them with patients after neurosurgical and abdominal procedures. We conducted a prospective observational study in infants who underwent congenital cardiac surgery, visceral surgery, and neurosurgical procedures to measure parameters of cerebral macro- and microcirculation. Doppler ultrasound of anterior cerebral artery was performed, along with measurements of microcirculatory parameters using O2C device. 89 infants were included in the study. Group 1 (n = 35) comprised children after corrective cardiac surgery, group 2 (n = 22), after aortopulmonary shunt procedures, group 3 (n = 11), after Glenn operations, and group 4 (n = 21), after abdominal or neurosurgical procedures. The systolic peak flow was significantly lower in groups 2 and 3 compared to groups 1 and 4, 52.3 and 56.7 versus 59.6 and 68.8 cm/s, p = 0.01, respectively. Pulsatility index was higher in patients of group 2 compared to groups 1, 3 and 4, 2.5 vs. 1.3, 1.4, and 1.5 (p < 0.001), respectively. The cerebral blood flow in the staged palliation groups (2 and 3) was lower compared to groups 1 and 4, 203 and 236 vs. 250 and 262 AU, p = 0.045. Children undergoing staged palliation may show variations in cerebral macro- and microcirculation. Both approaches described in our study provide complementary information and can accordingly be utilized in the postoperative intensive care period. Future studies should focus on establishing reference values for macro- and microcirculation parameters across various patient populations.