Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion

Dent, Catherine L.; Spaeth, James P.; Jones, Blaise V.; Schwartz, Steven M.; Glauser, Tracy A.; Hallinan, Barbara; Pearl, Jeffrey M.; Khoury, Philip R.; Kurth, C. Dean

doi:10.1016/j.jtcvs.2005.07.051

Cited by 156 publications

(61 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10–12 These previous studies have identified possible risk factors for this injury such as brain immaturity, duration of deep hypothermic circulatory arrest, and post-operative cerebral oxygenation. 12–14 However, most previous studies have been in mixed populations of neonates with various forms of CHD. Herein we investigate a homogeneous cohort of neonates with hypoplastic left heart syndrome (HLHS).…”

Section: Introductionmentioning

confidence: 99%

Time to surgery and preoperative cerebral hemodynamics predict postoperative white matter injury in neonates with hypoplastic left heart syndrome

Lynch¹,

Buckley

Schwab

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

120

View full text Add to dashboard Cite

Objective Hypoxic-ischemic white mater brain injury commonly occurs in neonates with hypoplastic left heart syndrome (HLHS). Approximately half of the HLHS survivors exhibit neurobehavioral symptoms believed to be associated with this injury, though the exact timing of the injury is not known. Methods Neonates with HLHS were recruited for pre- and post-operative monitoring of cerebral oxygen saturation (ScO2), cerebral oxygen extraction fraction (OEF), and cerebral blood flow (CBF) using two non-invasive optical-based techniques, namely diffuse optical spectroscopy and diffuse correlation spectroscopy. Anatomical magnetic resonance imaging (MRI) scans were performed prior to and approximately one week after surgery in order to quantify the extent and timing of the acquired white matter injury. Risk factors for developing new or worsened white matter injury were assessed using uni- and multi-variate logistic regression. Results Thirty-seven neonates with HLHS were studied. In a univariate analysis, neonates who developed a large volume of new, or worsened, postoperative white matter injury had a significantly longer time-to-surgery (p=0.0003). In a multivariate model, longer time between birth and surgery (i.e., time-to-surgery), delayed sternal closure, and higher pre-operative CBF were predictors of post-operative white matter injury. Additionally, longer time-to-surgery and higher pre-operative CBF on morning of surgery were correlated with lower ScO2 (p=0.03 and p=0.05) and higher OEF (p=0.05 and p=0.05). Conclusions Longer time-to-surgery is associated with new post-operative white matter injury in otherwise healthy neonates with HLHS. The results suggest that earlier Norwood palliation may decrease the likelihood of acquiring postoperative white matter injury.

show abstract

Section: Introductionmentioning

confidence: 99%

Time to surgery and preoperative cerebral hemodynamics predict postoperative white matter injury in neonates with hypoplastic left heart syndrome

Lynch¹,

Buckley

Schwab

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

120

View full text Add to dashboard Cite

show abstract

“…In a recent study, all five postoperative strokes occurred following regional cerebral perfusion in infants with a single ventricle who were undergoing the Norwood procedure and had imaging characteristics suggesting embolism as a possible mechanism 19. In contrast, new postoperative white matter injury is specifically associated with low blood pressure during the first postoperative day, and to low postoperative cerebral saturation measured by NIRS (relative cerebral desaturation) 19 20 22. Following cardiopulmonary bypass, a pattern of selective cerebral desaturation is often noted, especially with the bypass method of regional cerebral perfusion 23 24.…”

Section: Physiological Mechanisms Of Brain Injurymentioning

confidence: 99%

“…Following cardiopulmonary bypass, a pattern of selective cerebral desaturation is often noted, especially with the bypass method of regional cerebral perfusion 23 24. During the first postoperative day in newborns with hypoplastic left heart syndrome, cerebral oxygen saturation below 45% for longer than 3 h22 and low diastolic blood pressure20 are associated with brain injury. In a recent series of newborns with hypoplastic left heart syndrome, those with adverse neurodevelopmental outcome had decreased systemic oxygen delivery postoperatively 25.…”

Section: Physiological Mechanisms Of Brain Injurymentioning

confidence: 99%

Neurology of congenital heart disease: insight from brain imaging

Miller

McQuillen

2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

View full text Add to dashboard Cite

“…Reliable methods for detecting cerebral ischemia during cardiopulmonary bypass (CPB) and the early postoperative period could allow for development of strategies to improve neurologic outcomes[1, 2]. Our group has previously shown that deep hypothermic circulatory arrest (DHCA) duration and intraoperative cerebral oxygen saturation (rSO 2 ) are associated with neurodevelopmental outcome[3, 4].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Blood Flow Velocity and Neurodevelopmental Outcome in Infants Undergoing Surgery for Congenital Heart Disease

Cheng

Wypij

Laussen

et al. 2014

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Background Cerebral blood flow velocity (CBFV) measured by transcranial Doppler sonography has provided information on cerebral perfusion in patients undergoing infant heart surgery, but no studies have reported a relationship to early postoperative and long-term neurodevelopmental outcomes. Methods CBFV was measured in infants undergoing biventricular repair without aortic arch reconstruction as part of a trial of hemodilution during cardiopulmonary bypass (CPB). CBFV (Vm, mean; Vs, systolic; Vd, end-diastolic) in the middle cerebral artery and change in Vm (rVm) were measured intraoperatively and up to 18 hours post-CPB. Neurodevelopmental outcomes, measured at 1 year of age, included the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development-II. Results CBFV was measured in 100 infants: 43 with D-transposition of the great arteries, 36 with tetralogy of Fallot, and 21 with ventricular septal defects. Lower Vm, Vs, Vd, and rVm at18 hours post-CPB were independently related to longer ICU duration of stay (P<0.05). In the 85 patients who returned for neurodevelopmental testing, lower Vm, Vs, Vd and rVm at 18 hours post-CPB were independently associated with lower PDI (P<0.05) and MDI (P<0.05, except Vs: P=0.06) scores. Higher Vs and rVm at 18 hours post-CPB were independently associated with increased incidence of brain injury on MRI in 39 patients. Conclusions Postoperative CBFV after biventricular repair is related to early postoperative and neurodevelopmental outcomes at 1 year of age, possibly indicating that low CBFV is a marker of suboptimal postoperative hemodynamics and cerebral perfusion.

show abstract

Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion

Cited by 156 publications

References 26 publications

Time to surgery and preoperative cerebral hemodynamics predict postoperative white matter injury in neonates with hypoplastic left heart syndrome

Time to surgery and preoperative cerebral hemodynamics predict postoperative white matter injury in neonates with hypoplastic left heart syndrome

Neurology of congenital heart disease: insight from brain imaging

Cerebral Blood Flow Velocity and Neurodevelopmental Outcome in Infants Undergoing Surgery for Congenital Heart Disease

Contact Info

Product

Resources

About