Detection of false lumen perfusion at the beginning of cardiopulmonary bypass in patients undergoing repair of aortic dissection

Objective: In patients undergoing surgical repair of aortic dissection, fal se lumen perfusion during cardiopulmonary bypass may produce central nervou s system damage, myocardial ischemia, aortic rupture, and death. We describ e a method to detect false lumen perfusion at the beginning of retrograde a ortic perfusion that may prevent these complications. Design: Sonicated albumin microbubbles (8 mt) were injected through a side branch of the extracorporeal circulation line to detect true lumen and/or f alse lumen perfusion of the thoracic aorta at the beginning of cardiopulmon ary bypass. Transesophageal echocardiography was used to image aortic perfu sion. Setting: The study was performed in a cardiac surgery theater. Patients: A total of 27 consecutive patients undergoing operation for Type I aortic dissection were studied, interventions: All patients underwent sur gical repair of aortic dissection and retrograde aortic perfusion through o ne femoral artery. Measurements and Main Results: Patients were divided into three groups: Gro up I, those having adequate true lumen perfusion: brisk appearance and wash out of contrast in the true lumen with no, poor, or delayed opacification o f the false lumen; Group II, those having mixed true lumen and false lumen perfusion: simultaneous opacification of both lumens; Group Ill, those havi ng inappropriate false lumen perfusion: same criteria as for adequate true lumen perfusion applied to the false lumen. The true lumen was perfused in 13 patients, both lumens in 11 patients, and false lumen alone in three pat ients. In these three patients, cannulation was repeated through the contra lateral femoral artery with restoration of true lumen perfusion; the first patient died of diffuse cerebral ischemic damage and renal failure, another one experienced temporary postoperative monoparesis, and the fast had no n eurologic sequelae. Conclusions: Contrast echocardiography allows immediate detection of retrog rade aortic perfusion during cardiopulmonary bypass and may help prevent ne urologic complications and death in patients with Type I dissection.