Favorable Neurological Recovery After Prolonged Absence of Antegrade Cerebral Blood Flow During Congenital Heart Surgery: A Case Suggesting the Role of Retrograde Perfusion.

Intraoperative cardiac arrest during pediatric congenital heart disease surgery is rare but associated with high mortality and poor neurological outcomes. While cerebral perfusion during cardiopulmonary resuscitation is typically antegrade, retrograde cerebral flow has not been reported. We report a case of a 12-year-old girl undergoing pulmonary artery debanding for congenitally corrected transposition of the great arteries. Massive hemorrhage from pulmonary artery injury led to cardiac arrest, during which antegrade cerebral flow was likely absent for 15 minutes. Nevertheless, the patient recovered without neurological sequelae. Time-domain near-infrared spectroscopy showed increased deoxygenated hemoglobin and preserved total hemoglobin, suggesting cerebral perfusion via retrograde venous flow. Central venous pressure was maintained at 15-25 mmHg through rapid transfusion. This case suggests that retrograde cerebral perfusion may occur during cardiac arrest when central venous pressure is adequately maintained, potentially contributing to favorable neurological outcomes even in the absence of antegrade flow.