J.Jpn. Surg. Soc.. 56(9): 1150-1168, 1955

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EXPERIMENTAL AND CLINICAL STUDIES ON THE OPEN HEART SURGERY: ESPECIALLY ON THE SELECTIVE BRAIN COOLING

From the results of the experimental cardiac inflow occlusion both in normothermic and hypothermic dogs, the author confirmed that it was important to refrigerate the brain severely to protect animals from the cerebral anoxia for the prolonged circulatory arrest and to keep, on the contrary, the body temperature rather highly for the rapid recovery. From this standpoint the author devised the original method of the selective brain cooling as an aid to the cardiac surgery under the direct vision.
This apparatus is composed of a silicone-coaled glass coil (capacity : 100cc.), vinyl cannulae, three bubble traps and a DeBakey pump. The glass coil is inserted through the vinyl cannulae between the cardiac and the cerebral section of one common carotid artery as shown in the figure.
Twenty to thirty-four minutes after the cooling by brain perfusion, the rectal temperature was reduced to average 31.6°C, the brain temperalure of the perfused side to 14.2°C and the non-perfused side to 19.1°C. The changes of pulse rate, blood pressure, respiration and pupils with the progress of brain cooling were described. Among these changes the alteration of the blood pressure was most interesting. Rapid and severe reduction of the blood pressure was always observed with reversibility at the brain temperature below 20°C. This phenomenon was not considered as the effect of general hypothermia but as the effect of differential cerebral refrigeration.
The author performed experimental caval occlusion in various durations by this method and succeeded 50 minutes occlusion at 29.5°C in rectal temperature.
Performing the experiments of intracardiac procedure under the direct vision, this apparatus has been proved to have the advantage, at the reIease of caval occlusion, to be able to perfuse easily the ischemic myocardium with the oxygenated blood and also to close the aortic valve preventing the air embolism of the cerebral and the coronary arteries by the intra-arterial transfusion.
After the safety and the excellence of the selective brain cooling has been proved, tweIve clinical applications of this method were attempted in this surgical department. Five cases of atrial septal defect, one case of Fallot's tetralogy and one case of isolated ventricular septal defect were succssfully operated. In this series the rectal temperatures ranged from 31.6 to 34.1°C and that of the internal jugular vein from 13.4 to 19.9°C. The durations of the circulatory interruption extended from 8 to 13 minutes.
(author 's abstract)

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