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Thomas AR, Levy PT, Sperotto F, Braudis N, Valencia E, DiNardo JA, Friedman K, Kheir JN. Arch watch: current approaches and opportunities for improvement. J Perinatol 2024; 44:325-332. [PMID: 38129600 DOI: 10.1038/s41372-023-01854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
Coarctation of the aorta (CoA) is a ductus arteriosus (DA)-dependent form of congenital heart disease (CHD) characterized by narrowing in the region of the aortic isthmus. CoA is a challenging diagnosis to make prenatally and is the critical cardiac lesion most likely to go undetected on the pulse oximetry-based newborn critical CHD screen. When undetected CoA causes obstruction to blood flow, life-threatening cardiovascular collapse may result, with a high burden of morbidity and mortality. Hemodynamic monitoring practices during DA closure (known as an "arch watch") vary across institutions and existing tools are often insensitive to developing arch obstruction. Novel measures of tissue oxygenation and oxygen deprivation may improve sensitivity and specificity for identifying evolving hemodynamic compromise in the newborn with CoA. We explore the benefits and limitations of existing and new tools to monitor the physiological changes of the aorta as the DA closes in infants at risk of CoA.
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Affiliation(s)
- Alyssa R Thomas
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Francesca Sperotto
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Nancy Braudis
- Department of Nursing, Boston Children's Hospital, Boston, MA, USA
| | - Eleonore Valencia
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Kevin Friedman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John N Kheir
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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Brazhe NA, Thomsen K, Lønstrup M, Brazhe AR, Nikelshparg EI, Maksimov GV, Lauritzen M, Sosnovtseva O. Monitoring of blood oxygenation in brain by resonance Raman spectroscopy. JOURNAL OF BIOPHOTONICS 2018; 11:e201700311. [PMID: 29603883 DOI: 10.1002/jbio.201700311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
Blood oxygenation in cerebral vessels is an essential parameter to evaluate brain function and to investigate the coupling between local blood flow and neuronal activity. We apply resonance Raman spectroscopy in vivo to study hemoglobin oxygenation in cortex vessels of anesthetized ventilated mice. We demonstrate that the pairs of Raman peaks at 1355 and1375 cm-1 (symmetric vibrations of pyrrol half-rings in the heme molecule), 1552 and 1585 cm-1 and 1602 and 1638 cm-1 (vibrations of methine bridges in heme molecule) are reliable markers for quantitative estimation of the relative amount of oxyhemoglobin in venules, arterioles, and capillaries. in vivo measurements of blood oxygenation in the cortex of mice ventilated with inspiratory gas mixtures containing different amounts of oxygen-normoxia, hyperoxia and hypoxia-validate the proposed approach. Our method allows to visualize blood saturation with O2 in different microvascular networks.
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Affiliation(s)
- Nadezda A Brazhe
- Department of Biophysics, Biological Faculty, Moscow State University, Moscow, Russia
| | - Kirsten Thomsen
- Institute of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Department for Clinical Neurophysiology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Micael Lønstrup
- Institute of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Alexey R Brazhe
- Department of Biophysics, Biological Faculty, Moscow State University, Moscow, Russia
| | - Evelina I Nikelshparg
- Department of Biophysics, Biological Faculty, Moscow State University, Moscow, Russia
| | - Georgy V Maksimov
- Department of Biophysics, Biological Faculty, Moscow State University, Moscow, Russia
| | - Martin Lauritzen
- Institute of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Department for Clinical Neurophysiology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Olga Sosnovtseva
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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