RETROGRADE CEREBRAL PERFUSION - ANATOMIC STUDY OF THE DISTRIBUTION OFBLOOD TO THE BRAIN

Background. Despite apparently good clinical results with retrograde c erebral perfusion during operation on the aortic arch, there is still concern about the real distribution of the blood injected in the super ior vena cava to the brain, especially when the internal jugular vein is valvulated (88% of the cases). This anatomic study was carried out to determine how a liquid injected in the superior vena cava reaches t he brain. Methods. Three groups of adult cadavers (5, 5, and 3 cases, respectively) were injected with latex, colored blue, through a cannul a in the superior vena cava. In group I, 600 mt of latex was injected. Group II was identical except that a catheter had been inserted, befo re the injection, into the internal jugular vein to collapse the inter nal jugular vein valve, when existing. In group III, the azygos vein w as ligated. Results. The internal jugular vein was not valvulated in 2 cases in group I. In those 2 cases, latex was found up to the jugular foramen. In the other cases in group I, and in all cases in group II, where the internal jugular vein was valvulated, the following veins w ere injected: internal jugular vein up to the valve (almost no latex b eyond), azygos vein, inferior vena cava, renal veins, rachidian and pe rimedullar venous plexuses, and venous sinuses of the brain. In group III, no opacification was observed beyond ligated azygos vein or valvu lated internal jugular vein. Conclusions. Despite the fact that this s tudy was carried out on cadavers, one can assume that, during retrogra de cerebral perfusion, the azygos vein system is a major way to the ce ntral nervous system when the internal jugular vein is valvulated.