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

Abstract

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 (...

Neurodevelopmental Abnormalities and Congenital Heart Disease

“…A study comparing HUS and MRI demonstrated preoperative brain injury by MRI in 26% of infants with CHD whereas HUS only detected brain injury in 3% of infants – 80% of which were false-positives 40 . A recent study concluded that preoperative HUS in CHD infants undergoing surgery with cardiopulmonary bypass (CPB) were not predictive of neurodevelopmental outcomes at one year of age 41 .…”

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

“…Neonatal ultrasound imaging studies demonstrate cerebral abnormalities in 15–75% of neonates with CHD prior to surgery [3-7]. Most cerebral findings in CHD newborns are mild, such as asymmetrical widened ventricles and increased extracerebral fluid.…”

Scoring system for periventricular leukomalacia in infants with congenital heart disease

“…PVL occurs when immature glial precursor cells (premyelinating oligodendrocytes) within white matter are exposed to depressed oxygen levels and/or reduced blood flow (7). Newborns with PVL are at increased risk for permanent motor impairment and chronic neurological disabilities, including cerebral palsy, behavior deficits, and learning delays (8–11). The ability to assess the severity of PVL radiographically and to determine the relationship between imaging severity and clinical outcome is critical for physicians to provide proper guidance in long-term care and effective patient management.…”

“…Although several categorical systems exist, most are mainly modifications of a system proposed by Miller et al . (8), which stratifies lesions based on the number and size of white matter abnormities seen as T1 hyperintense lesions on magnetic resonance imaging (MRI) (3,11,13). The categorical scale can be performed quickly and does not require sophisticated equipment for postprocessing images, but the severity scaling of PVL may be inaccurate.…”