2019 Volume 39 Issue 2 Pages 119-124
A 76-year-old woman underwent an emergent Bentall procedure. Once deep hypothermia was achieved, retrograde cerebral perfusion was initiated through the superior vena cava cannula. However, the central venous pressure remained unchanged, and a gradual drop in cerebral oxygen saturation was observed on the left side shortly after initiation of retrograde perfusion. The retrograde flow was increased without any change in the central venous pressure. Mechanical causes such as cannula malposition and impaired oxygenation due to defective cardiopulmonary bypass were excluded. Transesophageal echocardiography revealed an enlarged right atrium and right ventricle. The left regional cerebral oxygen saturation eventually decreased from 73% to 27%. The total retrograde perfusion time was 26 minutes and the procedure was otherwise uneventful. The patient was discharged on postoperative day 16 without any neurological complication. Postoperative computed tomography revealed a partial anomalous pulmonary venous connection from the left upper pulmonary vein to the innominate vein.
