Major aortopulmonary collateral arteries (MAPCAs) provide significant issues during cardiopulmonary bypass, including flooding of the surgical field which requires significant blood volumes to be returned to the extracorporeal circuit via handheld suckers. This has been shown to be the major source of gaseous microemboli and is associated with adverse neurological outcome. Use of pH-stat has been previously shown to decrease the shunt through MAPCAs via an unknown mechanism. Here, we report the associated benefits of pH-stat in decreasing sucker usage and gaseous microemboli in a patient with known MAPCAs presenting for repair of tetralogy of Fallot and pulmonary atresia.
SakamotoTKurosawaHShin‘okaTAokiMIsomatsuY. The influence of pH strategy on cerebral and collateral circulation during hypothermic cardiopulmonary bypass in cyanotic patients with heart disease: results of a randomized trial and real-time monitoring. J Thorac Cardiovasc Surg2004; 127: 12–19.
2.
IchikawaHYagiharaTKishimotoH. Extent of aortopulmonary collateral blood flow as a risk factor for Fontan operations. Ann Thorac Surg1995; 59: 433–437.
3.
MorrayJPLynnAMMansfieldPB. Effect of pH and pCO2 on pulmonary and systemic hemodynamics after surgery in children with congenital heart disease and pulmonary hypertension. J Pediatr1988; 113: 474–479.
4.
ChangACZuckerHAHickeyPRWesselDL. Pulmonary vascular resistance in infants after cardiac surgery: role of carbon dioxide and hydrogen ion. Crit Care Med1995; 23: 568–574.
