PEDIATRICS Vol. 83 No. 3 March 1989, pp. 343-347
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Circle of Willis Blood Velocity and Flow Direction After Common Carotid Artery Ligation for Neonatal Extracorporeal Membrane Oxygenation

Tonse N. K. Raju MD1, Shin Y. Kim PhD1, Janet L. Meller MD1, Gopal Srinivasan MD1, Vivek Ghai MD1, and Hernan Reyes MD1

1 The Departments of Pediatrics and Surgery, University of Illinois College of Medicine at Chicago, and Cook County Hospital, Chicago

The velocity and direction of blood flow in the circle of Willis arteries were measured in three infants who underwent right common carotid artery ligation for extracorporeal membrane oxygenation treatment. Within 15 minutes of common carotid artery ligation, blood flow was detected in one infant's right middle cerebral artery; however, the velocity was reduced to 50% of the preextracorporeal membrane oxygenation level. The velocity remained 50% to 70% lower than normal during the 88 hours of extracorporeal membrane oxygenation therapy. In the other two infants, the velocity changes were less severe. By 2 to 10 weeks after weaning from extracorporeal membrane oxygenation, the velocities in the left cerebral arteries were increased to 116% to 217% of the corresponding right cerebral vessels. Following common carotid artery ligation, a retrograde direction of flow was noted in the first (A1) segment of the right anterior cerebral artery and in the right posterior communicating artery, whereas the direction of flow was normal in the corresponding vessels on the left. After common carotid artery ligation, the vertebrobasilar and the contralateral internal carotid systems appear to be the main sources of reperfusion of the right cerebral hemisphere via the circle of Willis. Furthermore, because of the known variants of the circle anatomy, a noninvasive pulsed Doppler method could be used to evaluate the flow patterns in the circle of Willis arteries, both before and after common carotid artery ligation for extracorporeal membrane oxygenation.

Key Words: extracorporeal membrane oxygenation • cerebral blood flow • ultrasound • Doppler • circle of Willis • cerebral artery • newborn • premature infant

Submitted on August 21, 1987
Accepted on February 25, 1988




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