Pre-Operative Brain Injury in Newborn Infants With Transposition of the Great Arteries Occurs at Rates Similar to Other Complex Congenital Heart Disease and Is Not Related to Balloon Atrial Septostomy

Beca, John; Gunn, Julia; Coleman, Lee; Hope, Ayton; Whelan, Laura Clare; Gentles, Thomas L.; Inder, Terrie E.; Hunt, Rod W.; Shekerdemian, Lara

doi:10.1016/j.jacc.2009.01.061

Cited by 119 publications

(100 citation statements)

References 14 publications

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“…A number of studies have reported the rate of preoperative brain injury on MRI in young infants undergoing surgery for CHD to be between 25% and 40%. [12][13][14][15][16] In noncardiac infant populations, MRI has been shown to be superior to HUS in sensitivity and specificity for detection of brain injury, which included white matter abnormalities or periventricular leukomalacia (PVL), 6 ischemia, 17 and hemorrhage, 6,17 but this comparison has not been made in infants with CHD.…”

Section: What This Study Addsmentioning

confidence: 99%

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Routine head ultrasound scans (HUSs) are frequently performed in the preoperative evaluation of the infants with congenital heart disease, and brain MRI is being increasingly used in the research setting. The utility of HUSs in this population has not yet been established. WHAT THIS STUDY ADDS:This is the first study to prospectively evaluate the utility of routine HUSs compared with MRIs in asymptomatic newborns and young infants undergoing cardiac surgery. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD.abstract OBJECTIVE: The purpose of this study was to assess the utility of preoperative head ultrasound scan (HUS) in a cohort of newborns also undergoing preoperative MRI as part of a prospective research study of brain injury in infants having surgery for congenital heart disease (CHD). METHODS: A total of 167 infants diagnosed with CHD were included in this 3-center study. None of the patients had clinical signs or symptoms of preoperative brain injury, and all patients received both HUS and brain MRI before undergoing surgical intervention. HUS and MRI results were reported by experienced neuroradiologists who were blinded to any specific clinical details of the study participants. The findings of the individual imaging modes were compared to evaluate for the presence of brain injury. RESULTS: Preoperative brain injury was present on HUS in 5 infants (3%) and on MRI in 44 infants (26%) (P , .001). Four of the HUS showed intraventricular hemorrhage not seen on MRI, suggesting false-positive results, and the fifth showed periventricular leukomalacia. The predominant MRI abnormality was white matter injury (n = 32). Other findings included infarct (n = 16) and hemorrhage (n = 5). CONCLUSIONS: Preoperative brain injury on MRI was present in 26% of infants with CHD, but only 3% had any evidence of brain injury on HUS. Among positive HUS, 80% were false-positive results. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD, and MRI may be a preferable tool when the assessment of these infants is warranted. Pediatrics 2013;131:e1765-e1770 Neurodevelopmental impairment is the most common long-term, noncardiac morbidityaffecting neonates undergoing surgery for congenital heart disease (CHD). The impact of this impairment is far-reaching and may not be manifest very early in life but instead may become apparent in later childhood, often extending into adolescence. [1][2][3][4][5] Given the potential relationship between brain injury and impaired outcome, and the possibility that aspects of cardiac surgery could further worsen preexisting brain injury, preoperative brain imaging is commonly used in the clinical setting as well as in the context of prospective investigations of brain injury in this highrisk group.The spectrum of brain injury affecting newborns with heart disease includes stroke or infarct, hemorrhage, and white matter injury (...

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Section: What This Study Addsmentioning

confidence: 99%

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

et al. 2013

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“…3 These acquired abnormalities often predate surgery, but new postoperative changes are also common. [4][5][6][7][8][9] In addition to demonstrating acquired brain lesions, recent studies have suggested that newborns with CHD may have immature brains relative to their gestational age. 4,8,10 Although there is widespread agreement that acquired brain injury on MRI is common in young infants with CHD, there is less consensus on an injury classification system for this.…”

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New White Matter Brain Injury After Infant Heart Surgery Is Associated With Diagnostic Group and the Use of Circulatory Arrest

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Background-Abnormalities on magnetic resonance imaging scans are common both before and after surgery for congenital heart disease in early infancy. The aim of this study was to prospectively investigate the nature, timing, and consequences of brain injury on magnetic resonance imaging in a cohort of young infants undergoing surgery for congenital heart disease both with and without cardiopulmonary bypass. Methods and Results-A total of 153 infants undergoing surgery for congenital heart disease at <8 weeks of age underwent serial magnetic resonance imaging scans before and after surgery and at 3 months of age, as well as neurodevelopmental assessment at 2 years of age. White matter injury (WMI) was the commonest type of injury both before and after surgery. It occurred in 20% of infants before surgery and was associated with a less mature brain. New WMI after surgery was present in 44% of infants and at similar rates after surgery with or without cardiopulmonary bypass. The most important association was diagnostic group (P<0.001). In infants having arch reconstruction, the use and duration of circulatory arrest were significantly associated with new WMI. New WMI was also associated with the duration of cardiopulmonary bypass, postoperative lactate level, brain maturity, and WMI before surgery. Brain immaturity but not brain injury was associated with impaired neurodevelopment at 2 years of age. Conclusions-New WMI is common after surgery for congenital heart disease and occurs at the same rate in infants undergoing surgery with and without cardiopulmonary bypass. New WMI is associated with diagnostic group and, in infants undergoing arch surgery, the use of circulatory arrest. (Circulation. 2013;127:971-979.)

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“…[10][11][12][13] These injuries consist predominantly of white matter injury (WMI), a pattern of injury commonly diagnosed in premature newborns. 11,12,[14][15][16][17] Neuroimaging measures consistent with delayed brain development are increasingly recognized in the term CHD population, even prior to surgery 18,19 and in utero. 20 A complex interplay between neonatal brain injury and abnormal brain development, reflected in impaired microstructure and metabolism, is increasingly appreciated.…”

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Brain injury and development in newborns with critical congenital heart disease

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Objective: To determine the relationship between radiologically identifiable brain injuries and delayed brain development as reflected by brain metabolic and microstructural integrity.Methods: Term newborns with congenital heart disease (CHD) (120 preoperatively and 104 postoperatively) were studied with MRI to determine brain injury severity (BIS), microstructure reflected by fractional anisotropy (FA) and average diffusivity (D av ), and metabolism reflected by N-acetylaspartate (NAA)/choline (Cho) and lactate/Cho. Brain development is characterized by increasing NAA/Cho and white matter FA, and by decreasing D av and lactate/Cho. GLOSSARYBIS 5 brain injury severity; CHD 5 congenital heart disease; CPB 5 cardiopulmonary bypass; D av 5 average diffusivity; DTI 5 diffusion tensor imaging; FA 5 fractional anisotropy; HI 5 hypoxic ischemic; IVH 5 intraventricular hemorrhage; MRSI 5 magnetic resonance spectroscopic imaging; NAA 5 N-acetylaspartate; SNAP-PE 5 Score for Neonatal Acute PhysiologyPerinatal Extension; SVP 5 single ventricle physiology; TGA 5 transposition of the great arteries;

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Pre-Operative Brain Injury in Newborn Infants With Transposition of the Great Arteries Occurs at Rates Similar to Other Complex Congenital Heart Disease and Is Not Related to Balloon Atrial Septostomy

Cited by 119 publications

References 14 publications

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

New White Matter Brain Injury After Infant Heart Surgery Is Associated With Diagnostic Group and the Use of Circulatory Arrest

Brain injury and development in newborns with critical congenital heart disease

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