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.2005.10.003

Cited by 225 publications

(188 citation statements)

References 29 publications

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“…The clinical application of NIRS is especially important in detecting hypoxia for preventing hypoxic damage in the neonatal brain. Earlier experimental and human studies in neonatal animals (1-to 3-day-old piglets) and term neonates, respectively, almost always performed with the older (adult) sensors showed that rScO 2 values <35-44% for at least 30-60 min lead to functional and/ or anatomical hypoxic brain damage (21)(22)(23). The new information gathered in this study strongly suggest that the lower limit of acceptable rScO 2 values obtained with the neonatal sensors, irrespective which NIRS device has been used, will be higher.…”

Section: Resultsmentioning

confidence: 99%

Comparing near-infrared spectroscopy devices and their sensors for monitoring regional cerebral oxygen saturation in the neonate

et al. 2013

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Background: Near-infrared spectroscopy (NIRS) is an upcoming clinical method for monitoring regional cerebral oxygen saturation (rScO 2 ) in neonates. There is a growing market offering different devices and sensors. Even though this technique is increasingly clinically applied, little is known about the similarities and/or differences in rScO 2 values between the different devices and sensors. The aim of this study was to compare the rScO 2 values obtained in (preterm) neonates with all available sensors of three frequently used NIRS devices. Methods: Fifty-five neonates admitted to our neonatal intensive care unit (NICU) were included in this study. rScO 2 was simultaneously monitored bilaterally with two different NIRS sensors (left and right frontoparietal) for at least 1 h. Then, the sensors were switched, and measurements were collected for at least another hour. results: We detected a rather close correlation between all investigated sensors from the three different NIRS devices, but absolute rScO 2 values showed substantial differences: BlandAltman analysis showed average differences from 10 to 15%. conclusion: Although the rScO 2 values correlated well between different NIRS sensors, sometimes there were substantial differences between the absolute rScO 2 values, which may complicate clinical application.

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Section: Resultsmentioning

confidence: 99%

Comparing near-infrared spectroscopy devices and their sensors for monitoring regional cerebral oxygen saturation in the neonate

et al. 2013

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“…A previous study of cerebral oxygenation in neonates with TGA undergoing an arterial switch operation showed a trend toward a less favorable neurodevelopmental outcome in neonates with a preoperative r c SO 2 <35%, as compared with neonates with a higher preoperative r c SO 2 (15). Another study in neonates with hypoplastic left heart syndrome undergoing Norwood 1 palliation showed that a prolonged r c SO 2 <45% in the postoperative period was associated with brain injury as detected on postoperative magnetic resonance imaging scans (16). In our study, the median r c SO 2 in the BAS group was 42% before BAS, which means that a considerable proportion of these neonates may have been at risk of developing brain injury.…”

Section: Discussionmentioning

confidence: 94%

“…Both measures give an impression of cerebral hypoxia and ischemia (12)(13)(14). Although previous studies have used NIRS monitoring to study cerebral oxygenation in neonates with congenital heart disease, most of this work has concentrated on intraoperative and postoperative factors (8,15,16). Little is known about the effects of preoperative interventions on cerebral oxygenation in neonates with congenital heart disease and their relationships to neonatal brain injury and neurodevelopmental outcome.…”

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confidence: 99%

Effect of balloon atrial septostomy on cerebral oxygenation in neonates with transposition of the great arteries

et al. 2012

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Background:The aim of this study was to determine the effect of balloon atrial septostomy (Bas) on cerebral oxygenation in neonates with transposition of the great arteries (TGa). Methods: In term neonates with TGa, regional cerebral tissue oxygen saturation (r c sO 2 ) was measured using near-infrared spectroscopy (NIRs) for a period of 2 h, before Bas, after Bas, and 24 h after Bas. In neonates who did not require Bas on clinical grounds, r c sO 2 was measured within 24 h of admission and 24 h later. results: Bas was performed in 12 of 21 neonates. r c sO 2 increased from a median of 42% (before) to 48% at 2 h after Bas (P < 0.05), as did transcutaneous arterial oxygen saturation (spO 2 ) (from 72% to 85%, P < 0.01). r c sO 2 increased further during the next 24 h (from 48% to 64%, P < 0.05), whereas spO 2 remained stable. although beginning from a lower baseline (42 vs. 51%, P < 0.01), r c sO 2 was higher in neonates treated with Bas, as compared with neonates not treated with Bas, 24 h after the procedure (64 vs. 58%, P < 0.05); spO 2 was, however, similar between the two groups. conclusion: Bas improves cerebral oxygen saturation in neonates with TGa. complete recovery of cerebral oxygen saturation occurred only 24 h after Bas.

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“…Several studies suggested that longer duration of deep hypothermic circulatory arrest is associated with neurocognitive impairment (12)(13)(14), but despite the missing evidence of a clear time limit (12,15), perioperative seizures with impaired motor development (16) and brain damage evident on MRI were consistent with RCP as well (10,17,18). Nevertheless, improved outcome reports (early and late) about shorter postoperative ventilation, improved renal function and adequate time-related neurodevelopment have been subsequently published after using RCP (15,19,20).…”

Section: Review Articlementioning

confidence: 99%

“…Low intraoperative rSO 2 -level may impact psychomotor development (15,30,31) and correlate with postoperative cerebral lesions diagnosed by magnetic resonance imaging (15,17,18,23,(31)(32)(33). On the other hand, particularly in the context of aortic arch surgery using RCP, measuring TAV may avoid the potential dangers of excessive cerebral blood flow resulting in cerebral edema or intracranial hemorrhage (22,34).…”

Section: Review Articlementioning

confidence: 99%

Goal-directed-perfusion in neonatal aortic arch surgery

Cesnjevar¹,

Purbojo²,

Muench³

et al. 2016

Transl. Pediatr.

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Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve. Thus concepts of deep hypothermic circulatory arrest (DHCA), regional cerebral perfusion (RCP/with cardioplegic cardiac arrest or on the perfused beating heart) and TBP exist in parallel and all carry an individual risk for organ damage related to perfusion management, chosen core temperature and time on bypass. Patient safety relies more and more on adequate end organ perfusion on cardiopulmonary bypass, especially sensitive organs like the brain, heart, kidney, liver and the gut, whereby on adequate tissue protection, temperature management and oxygen delivery should be visualized and monitored.

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

Cited by 225 publications

References 29 publications

Comparing near-infrared spectroscopy devices and their sensors for monitoring regional cerebral oxygen saturation in the neonate

Comparing near-infrared spectroscopy devices and their sensors for monitoring regional cerebral oxygen saturation in the neonate

Effect of balloon atrial septostomy on cerebral oxygenation in neonates with transposition of the great arteries

Goal-directed-perfusion in neonatal aortic arch surgery

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