Bilateral monitoring of cerebral oxygen saturation results in recognition of aortic cannula malposition during pediatric congenital heart surgery.

Congenital heart surgery is associated with a 2-25% reported incidence of neurological complication. Near-infrared spectroscopy (NIRS) can detect changes in regional cerebral saturation index (rSO2i) during cardiac surgery. If rSO2i decreases significantly, treatment algorithms are used to restore baseline values, potentially avoiding neurological complications. The efficacy of bilateral NIRS monitoring in pediatric congenital heart surgery has been debated. We report a case in which bilateral NIRS monitoring detected an abrupt decrease in rSO2i (right greater than left) after initiation of bypass without abnormalities detected by standard monitors. This resulted in prompt surgical intervention that restored rSO2i, potentially preventing neurological injury.