Potential Role of Transfontanelle Ultrasound for Infants Undergoing Modified Blalock-Taussig Shunt.
OBJECTIVE
Transfontanelle ultrasound is a noninvasive method for assessing cerebral blood flow in neonates and infants. The authors applied this technique as a point-of-care tool, before and after modified Blalock-Taussig shunt procedure, to evaluate cerebral perfusion.


DESIGN
Retrospective, observational study.


SETTING
Tertiary care children's hospital.


PARTICIPANTS
Ten infants undergoing modified Blalock-Taussig shunt procedure.


OBSERVATION
Transfontanelle ultrasound examinations with modified resistive index were analyzed before and after the modified Blalock-Taussig shunt procedure.


MEASUREMENTS AND MAIN RESULTS
Two infants died and 2 patients required a revision procedure due to shunt thrombosis. Baseline-modified resistive index and regional cerebral oxygenation were comparable between the right and left hemisphere. However, after the procedure, the modified resistive index decreased at both sides of the internal carotid arteries compared with baseline values (p value right side = 0.012, left side = 0.036) and was greater at the ipsilateral internal carotid arteries with the shunt (p = 0.012, mean difference = 0.07, 95% confidence interval [CI] 0.02-0.12). Four infants with the large patent ductus arteriosus presented diastolic reverse flows at both internal carotid arteries at baseline. However, the diastolic reverse flow disappeared after the procedure. An infant who developed diastolic reverse flow after the procedure, died.


CONCLUSIONS
Transfontanelle ultrasound is a feasible tool for assessing the pattern of shunt flow and cerebral perfusion before and after the modified Blalock-Taussig shunt procedure. The transfontanelle ultrasound examinations may have potential role in assessing "over-shunting," but it needs more studies.
['Kim|Eun-Hee|EH|', 'Lee|Ji-Hyun|JH|', 'Song|In-Kyung|IK|', 'Kim|Hee-Soo|HS|', 'Jang|Young-Eun|YE|', 'Kim|Woong-Han|WH|', 'Kwak|Jae-Gun|JG|', 'Kim|Jin-Tae|JT|']
D058366:Blalock-Taussig Procedure D002560:Cerebrovascular Circulation D055762:Cranial Fontanelles D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D016343:Monitoring, Intraoperative D019095:Point-of-Care Systems D012189:Retrospective Studies D018084:Ultrasonography, Interventional
transfontanelle ultrasound modified Blalock-Taussig shunt cerebral perfusion