Single-Ventricle Physiology Reduces Cerebral Oxygen Delivery in a Piglet Model Marco Ricci, MD, Pierluca Lombardi, MD, Alvaro Galindo, MD, Ernesto Coscarella,

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Single-Ventricle Physiology Reduces Cerebral Oxygen Delivery in a Piglet Model Marco Ricci, MD, Pierluca Lombardi, MD, Alvaro Galindo, MD, Ernesto Coscarella, MD, Amelia Vasquez, Eliot Rosenkranz, MD The Annals of Thoracic Surgery Volume 80, Issue 2, Pages 686-694 (August 2005) DOI: 10.1016/j.athoracsur.2005.03.025 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Regional brain blood flow expressed as percentage change from baseline (gray bars) during the experimental time points (open bars = 30 minutes; hatched bars = 120 minutes). In controls, significant increases in blood flow were seen in the brain as a whole and in several selected brain regions (p < 0.05). In the single-ventricle physiology (SVP) group, regional increases in blood flow were modest (p = not significant), or absent, despite the hypoxemia and reduced arterial oxygen content associated with SVP. *p < 0.05 as compared with baseline by one-way ANOVA. **p < 0.05 as compared with 30 minutes by one-way ANOVA. The Annals of Thoracic Surgery 2005 80, 686-694DOI: (10.1016/j.athoracsur.2005.03.025) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Regional brain oxygen delivery expressed as percentage change from baseline (gray bars) during the experimental time points (open bars = 30 minutes; hatched bars = 120 minutes). In controls, significant increases in oxygen delivery were seen in the subtentorial regions, cerebellum, and hippocampus (p < 0.05). In the single-ventricle physiology (SVP) group, regional oxygen delivery trended down in nearly all regions after creation of SVP (p = not significant). In the cerebrum, cortex, and white matter the trend in declining oxygen delivery continued at 120 minutes. Intergroup differences (two-way ANOVA) indicating lower oxygen delivery to selected brain regions in the SVP group are shown in the Figure. *p < 0.05 as compared with baseline by one-way ANOVA. The Annals of Thoracic Surgery 2005 80, 686-694DOI: (10.1016/j.athoracsur.2005.03.025) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Oxygen (O2) consumption and fractional oxygen extraction during the experimental data points. Despite the trend for lower cerebral oxygen delivery and consumption in the single-ventricle physiology (SVP) group, oxygen fractional extraction failed to increase in these animals. None of the intergroup and within-group differences reached statistical significance by one-way and two-way ANOVA. (Gray bars = baseline; open bars = 30 minutes; hatched bars = 120 minutes.) The Annals of Thoracic Surgery 2005 80, 686-694DOI: (10.1016/j.athoracsur.2005.03.025) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Changes in cerebral oxygen consumption (cerebral metabolic rate [CMRO2]) and cerebral lactate utilization/production (CMRLact) as calculated from sampling the jugular vein versus the sagittal sinus during various experimental data points (n = 9) (2-way ANOVA; p = ns). There were no significant differences between the two techniques. (Solid line triangles = CMRLact jugular vein; dotted line triangles = CMRLact sagittal sinus; solid line boxes = CMRO2 jugular vein; dotted line boxes = CMRO2 sagittal sinus.) The Annals of Thoracic Surgery 2005 80, 686-694DOI: (10.1016/j.athoracsur.2005.03.025) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions