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Letters to the Editor

Reply to Ellenberger et al.

^a Department of Cardiac Surgery, ‘St. Ekaterina’ University Hospital, 1431 Sofia, Bulgaria
^b Department of Anatomy and Histology, Medical University, 1431 Sofia, Bulgaria

Received 7 August 2007; accepted 8 August 2007.

^_* Corresponding author. Address: Department of Cardiac Surgery, "St. Ekaterina" University Hospital, 52a "P. Slaveikov" blvd, 1431 Sofia, Bulgaria. Tel.: +359 889 700 343. (Email: vassil_papanchev{at}yahoo.com).

Key Words: Cardiac surgery • Vessels • Variations • Cerebral protection

We would like to thank Ellenberger et al. [1] for their interest in our article [2]. The authors added some important comments that were not discussed in detail in our work [2]. We agree with the authors’ opinion for stepwise multimodality neuroprotective strategy for each separate patient [1]. Such an approach will help to choose the most effective method for cerebral protection and will allow adequate intraoperative follow-up. Nevertheless we must always bear in mind that in some patients such profound preoperative examinations could not be possible, for example, some patients with aortic dissection diagnosed outside a specialized cardiac surgery center. We believe that in such cases bilateral selective cerebral perfusion should be the protective strategy of choice, since it will overcome the variations of circle of Willis, if such are present [2], and it could ensure adequate cerebral blood supply even in patients with uni- or bilateral internal carotid artery stenosis/occlusion.

Our work also stressed the fact that the results derived from animal models of selective cerebral perfusion must not be extrapolated to humans, since the cerebral blood supply of the animals’ brain is quite different from that in humans, namely the absence of the anterior communicating artery in most of the domestic animals (for example, pigs), extensive anastomoses between extra- and intracranial arteries and presence of variations of the circle of Willis in all species [2].

References

1. Ellenberger C, Panos A, Diaper J, Licker M. Guided cerebral protection in cardiac surgery. Eur J Cardiothorac Surg 2007;32:822-823.[Free Full Text]
2. Papantchev V, Hristov S, Todorova D, Naydenov E, Paloff A, Nikolov D, Tschirkov A, Ovtscharoff W. Some variations of the circle of Willis, important for cerebral protection in aortic surgery — a study in Eastern Europeans. Eur J Cardiothorac Surg 2007;31:982-989.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Dimitar Petkov Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Papantchev, V. Articles by Ovtscharoff, W. Search for Related Content PubMed Articles by Papantchev, V. Articles by Ovtscharoff, W. Related Collections Anesthesia Cerebral protection Extracorporeal circulation