Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use

B V Martherus; T Alderliesten; E M R Fonteyn; I Ceelie; D J van Vriesland; J Nijman; H Talacua; R A J Nievelstein; J Dudink; M J N L Benders; W F F A Buhre; K van Loon

doi:10.1002/pan.70106

Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use

B V Martherus
, T Alderliesten
, E M R Fonteyn
, I Ceelie
, D J van Vriesland
, J Nijman
, H Talacua
, R A J Nievelstein
, J Dudink
, M J N L Benders
, W F F A Buhre
, K van Loon

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood flow and can provide valuable insights into cerebral perfusion in neonates. Nevertheless, it has not been widely introduced in neonatal cardiac surgery.

AIMS: This study aims to evaluate the feasibility of continuous bilateral transcranial Doppler monitoring for assessing cerebral perfusion during neonatal cardiac surgery.

METHODS: Continuous transcranial Doppler monitoring was employed during neonatal cardiac surgery with a commercially available transcranial Doppler system and fixation materials. Cerebral blood flow velocity, invasive arterial blood pressure, and other key physiological parameters were measured throughout the procedures.

RESULTS: A total of 44 procedures were monitored. Four were excluded due to storage problems (n = 2), inadequate time to apply the probes (n = 1), and subject drop-out due to lower surgery severity (n = 1). Bilateral sufficient signal quality was obtained in all patients at the start. Unilateral signal deterioration occurred in 1 (2.5%) of left middle cerebral artery measurements and in 3 (7.5%) of right middle cerebral artery measurements. Mean (SD) left/right MCA CBFV were: pre-bypass 17.2 (6.4)/15.4 (6.8) cm/s, during bypass 10.8 (4.0)/10.2 (4.3) cm/s, and post-bypass 18.4 (5.9)/16.1 (5.1) cm/s. Mean (SD) ABP was 38.1 (4.4) mmHg pre-bypass, 38.0 (5.1) mmHg during bypass, and 47.8 (4.7) mmHg post-bypass.

CONCLUSIONS: This study demonstrates that bilateral transcranial Doppler monitoring is feasible during neonatal cardiac surgery when performed within the recommended operational safety limits. Transcranial Doppler provides real-time information on cerebral blood flow, complementing existing tools.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04713605.

Original language	English
Pages (from-to)	370-378
Number of pages	9
Journal	Paediatric Anaesthesia
Volume	36
Issue number	4
Early online date	24 Dec 2025
DOIs	https://doi.org/10.1002/pan.70106
Publication status	Published - Apr 2026

Keywords

cerebral blood flow
congenital heart disease
hemodynamic monitoring
neonate
transcranial doppler
ultrasonography

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Martherus, B. V., Alderliesten, T., Fonteyn, E. M. R., Ceelie, I., van Vriesland, D. J., Nijman, J., Talacua, H., Nievelstein, R. A. J., Dudink, J., Benders, M. J. N. L., Buhre, W. F. F. A., & van Loon, K. (2026). Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use. Paediatric Anaesthesia, 36(4), 370-378. https://doi.org/10.1002/pan.70106

@article{0e8cc8941f984ed29e899563d12e37d0,

title = "Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use",

abstract = "INTRODUCTION: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood flow and can provide valuable insights into cerebral perfusion in neonates. Nevertheless, it has not been widely introduced in neonatal cardiac surgery.AIMS: This study aims to evaluate the feasibility of continuous bilateral transcranial Doppler monitoring for assessing cerebral perfusion during neonatal cardiac surgery.METHODS: Continuous transcranial Doppler monitoring was employed during neonatal cardiac surgery with a commercially available transcranial Doppler system and fixation materials. Cerebral blood flow velocity, invasive arterial blood pressure, and other key physiological parameters were measured throughout the procedures.RESULTS: A total of 44 procedures were monitored. Four were excluded due to storage problems (n = 2), inadequate time to apply the probes (n = 1), and subject drop-out due to lower surgery severity (n = 1). Bilateral sufficient signal quality was obtained in all patients at the start. Unilateral signal deterioration occurred in 1 (2.5\%) of left middle cerebral artery measurements and in 3 (7.5\%) of right middle cerebral artery measurements. Mean (SD) left/right MCA CBFV were: pre-bypass 17.2 (6.4)/15.4 (6.8) cm/s, during bypass 10.8 (4.0)/10.2 (4.3) cm/s, and post-bypass 18.4 (5.9)/16.1 (5.1) cm/s. Mean (SD) ABP was 38.1 (4.4) mmHg pre-bypass, 38.0 (5.1) mmHg during bypass, and 47.8 (4.7) mmHg post-bypass.CONCLUSIONS: This study demonstrates that bilateral transcranial Doppler monitoring is feasible during neonatal cardiac surgery when performed within the recommended operational safety limits. Transcranial Doppler provides real-time information on cerebral blood flow, complementing existing tools.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04713605.",

keywords = "cerebral blood flow, congenital heart disease, hemodynamic monitoring, neonate, transcranial doppler, ultrasonography",

author = "Martherus, \{B V\} and T Alderliesten and Fonteyn, \{E M R\} and I Ceelie and \{van Vriesland\}, \{D J\} and J Nijman and H Talacua and Nievelstein, \{R A J\} and J Dudink and Benders, \{M J N L\} and Buhre, \{W F F A\} and \{van Loon\}, K",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Pediatric Anesthesia published by John Wiley \& Sons Ltd.",

year = "2026",

month = apr,

doi = "10.1002/pan.70106",

language = "English",

volume = "36",

pages = "370--378",

journal = "Paediatric Anaesthesia",

issn = "1155-5645",

publisher = "John Wiley \& Sons Inc.",

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Martherus, BV, Alderliesten, T, Fonteyn, EMR, Ceelie, I, van Vriesland, DJ, Nijman, J, Talacua, H, Nievelstein, RAJ , Dudink, J , Benders, MJNL , Buhre, WFFA & van Loon, K 2026, 'Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use', Paediatric Anaesthesia, vol. 36, no. 4, pp. 370-378. https://doi.org/10.1002/pan.70106

TY - JOUR

T1 - Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use

AU - Martherus, B V

AU - Alderliesten, T

AU - Fonteyn, E M R

AU - Ceelie, I

AU - van Vriesland, D J

AU - Nijman, J

AU - Talacua, H

AU - Nievelstein, R A J

AU - Dudink, J

AU - Benders, M J N L

AU - Buhre, W F F A

AU - van Loon, K

PY - 2026/4

Y1 - 2026/4

N2 - INTRODUCTION: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood flow and can provide valuable insights into cerebral perfusion in neonates. Nevertheless, it has not been widely introduced in neonatal cardiac surgery.AIMS: This study aims to evaluate the feasibility of continuous bilateral transcranial Doppler monitoring for assessing cerebral perfusion during neonatal cardiac surgery.METHODS: Continuous transcranial Doppler monitoring was employed during neonatal cardiac surgery with a commercially available transcranial Doppler system and fixation materials. Cerebral blood flow velocity, invasive arterial blood pressure, and other key physiological parameters were measured throughout the procedures.RESULTS: A total of 44 procedures were monitored. Four were excluded due to storage problems (n = 2), inadequate time to apply the probes (n = 1), and subject drop-out due to lower surgery severity (n = 1). Bilateral sufficient signal quality was obtained in all patients at the start. Unilateral signal deterioration occurred in 1 (2.5%) of left middle cerebral artery measurements and in 3 (7.5%) of right middle cerebral artery measurements. Mean (SD) left/right MCA CBFV were: pre-bypass 17.2 (6.4)/15.4 (6.8) cm/s, during bypass 10.8 (4.0)/10.2 (4.3) cm/s, and post-bypass 18.4 (5.9)/16.1 (5.1) cm/s. Mean (SD) ABP was 38.1 (4.4) mmHg pre-bypass, 38.0 (5.1) mmHg during bypass, and 47.8 (4.7) mmHg post-bypass.CONCLUSIONS: This study demonstrates that bilateral transcranial Doppler monitoring is feasible during neonatal cardiac surgery when performed within the recommended operational safety limits. Transcranial Doppler provides real-time information on cerebral blood flow, complementing existing tools.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04713605.

AB - INTRODUCTION: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood flow and can provide valuable insights into cerebral perfusion in neonates. Nevertheless, it has not been widely introduced in neonatal cardiac surgery.AIMS: This study aims to evaluate the feasibility of continuous bilateral transcranial Doppler monitoring for assessing cerebral perfusion during neonatal cardiac surgery.METHODS: Continuous transcranial Doppler monitoring was employed during neonatal cardiac surgery with a commercially available transcranial Doppler system and fixation materials. Cerebral blood flow velocity, invasive arterial blood pressure, and other key physiological parameters were measured throughout the procedures.RESULTS: A total of 44 procedures were monitored. Four were excluded due to storage problems (n = 2), inadequate time to apply the probes (n = 1), and subject drop-out due to lower surgery severity (n = 1). Bilateral sufficient signal quality was obtained in all patients at the start. Unilateral signal deterioration occurred in 1 (2.5%) of left middle cerebral artery measurements and in 3 (7.5%) of right middle cerebral artery measurements. Mean (SD) left/right MCA CBFV were: pre-bypass 17.2 (6.4)/15.4 (6.8) cm/s, during bypass 10.8 (4.0)/10.2 (4.3) cm/s, and post-bypass 18.4 (5.9)/16.1 (5.1) cm/s. Mean (SD) ABP was 38.1 (4.4) mmHg pre-bypass, 38.0 (5.1) mmHg during bypass, and 47.8 (4.7) mmHg post-bypass.CONCLUSIONS: This study demonstrates that bilateral transcranial Doppler monitoring is feasible during neonatal cardiac surgery when performed within the recommended operational safety limits. Transcranial Doppler provides real-time information on cerebral blood flow, complementing existing tools.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04713605.

KW - cerebral blood flow

KW - congenital heart disease

KW - hemodynamic monitoring

KW - neonate

KW - transcranial doppler

KW - ultrasonography

UR - https://www.scopus.com/pages/publications/105025645411

U2 - 10.1002/pan.70106

DO - 10.1002/pan.70106

M3 - Article

C2 - 41439495

SN - 1155-5645

VL - 36

SP - 370

EP - 378

JO - Paediatric Anaesthesia

JF - Paediatric Anaesthesia

IS - 4

ER -

Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use

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