Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial

Bellinger, David C.; Wypij, David; duPlessis, Adré J.; Rappaport, Leonard; Jonas, Richard A.; Wernovsky, Gil; Newburger, Jane W.

doi:10.1016/s0022-5223(03)00711-6

Cited by 600 publications

(479 citation statements)

References 44 publications

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“…3,4 Quantification of the hemodynamic and metabolic state of these neonates via measurements of cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen consumption (CMRO 2 ) should provide valuable information toward understanding the interaction between cardiac pathophysiology and subsequent cerebral health. Potentially, such new knowledge could help predict and prevent adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygen Metabolism in Neonates with Congenital Heart Disease Quantified by MRI and Optics

Jain

Buckley

Licht

et al. 2013

J Cereb Blood Flow Metab

173

192

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Neonatal congenital heart disease (CHD) is associated with altered cerebral hemodynamics and increased risk of brain injury. Two novel noninvasive techniques, magnetic resonance imaging (MRI) and diffuse optical and correlation spectroscopies (diffuse optical spectroscopy (DOS), diffuse correlation spectroscopy (DCS)), were employed to quantify cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) of 32 anesthetized CHD neonates at rest and during hypercapnia. Cerebral venous oxygen saturation (S v O 2 ) and CBF were measured simultaneously with MRI in the superior sagittal sinus, yielding global oxygen extraction fraction (OEF) and global CMRO 2 in physiologic units. In addition, microvascular tissue oxygenation (StO 2 ) and indices of microvascular CBF (BFI) and CMRO 2 (CMRO 2i ) in the frontal cortex were determined by DOS/DCS. Median resting-state MRI-measured OEF, CBF, and CMRO 2 were 0.38, 9.7 mL/minute per 100 g and 0.52 mL O 2 /minute per 100 g, respectively. These CBF and CMRO 2 values are lower than literature reports for healthy term neonates (which are sparse and quantified using different methods) and resemble values reported for premature infants. Keywords: cerebral blood flow; cerebral hemodynamics; diffuse optics; MRI; near-infrared spectroscopy; neonatal ischemia INTRODUCTION Congenital heart disease (CHD) affects B35,000 neonates each year in the United States. These patients suffer both short-and long-term neurologic sequelae. Periventricular leukomalacia is the most common cerebral injury found in this population. This type of injury is characterized by focal necrosis in the periventricular white matter, and it is associated with pyknotic glial nuclei and reactive gliosis. 1,2 During the early stages of brain development, the oligodendrocyte (brain glial cells) precursors are metabolically very active and highly susceptible to injury from reduced blood flow and oxygen delivery. Hence, hypoxiaischemia has been implicated as a major cause of this injury in CHD neonates.Periventricular leukomalacia leads to impaired myelination and has been linked to worse neurodevelopmental outcomes in premature infants and postulated to cause (at least in part) the impaired cognition and cerebral palsy commonly seen in this cohort of infants with CHD. 3,4 Quantification of the hemodynamic and metabolic state of these neonates via measurements of cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen consumption (CMRO 2 ) should provide valuable information toward understanding the interaction between cardiac pathophysiology and subsequent cerebral health. Potentially, such new knowledge could help predict and prevent adverse outcomes.

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Section: Introductionmentioning

confidence: 99%

Cerebral Oxygen Metabolism in Neonates with Congenital Heart Disease Quantified by MRI and Optics

Jain

Buckley

Licht

et al. 2013

J Cereb Blood Flow Metab

173

192

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“…recent studies have assessed the influence of diverse circulatory bypass techniques on the neuropsychomotor development of newborns with transposition of the great arteries [1][2][3][4][5][6] . More recently, the repercussions of circulatory bypass and moderate hypothermia for the correction of common defects, such as septal defects and tetralogy of Fallot, have been studied [7][8][9][10] . It is known that infants with congenital heart disease have low weight gain [11][12][13][14][15][16][17][18][19][20] .…”

Section: Dra Taís Sica Da Rocha -Rua Farias Santos 500/301 -90670-15mentioning

confidence: 99%

Neuropsychomotor development before and after open-heart surgery in infants

Rocha

Guardiola

Piva

et al. 2009

Arq. Neuro-Psiquiatr.

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-There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67±23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.Key WorDs: cardiac surgery, developmental delay, Denver II test.desenvolvimento neuropsicomotor de lactentes antes e após cirurgia cardíaca resumo -As alterações neurológicas em lactentes com cardiopatia congênita podem agravar seu quadro clínico e levar a seqüelas permanentes. Foi realizada uma coorte prospectiva, com 20 lactentes, com idade média de 6,7±4,2 meses, avaliando-se o perfil de desenvolvimento e o estado nutricional. Utilizou-se o exame neurológico e o teste de Denver II. os testes foram aplicados 24h antes da cirurgia, na alta da unidade de terapia intensiva e 3 a 6 meses após. os defeitos septais ocorreram em 11 casos (55%). o tempo médio de circulação extra-corpórea foi de 67±23,6 minutos. Quinze crianças tinham exame neurológico alterado e atraso no desenvolvimento neuropsicomotor antes da cirurgia, cuja normalização foi observada somente em seis após 6 meses .Quanto aos índices de Denver II, houve aumento em todos domínios, exceto o pessoalsocial. o escore Z médio para peso antes da cirurgia foi -2,814±1,98 e após -1,08±1,47 (p<0.05), o qual foi realizado em média 5.2±1.5 meses após a alta hospitalar. Melhora precoce tanto no desenvolvimento como no estado nutricional pôde ser observada neste grupo de lactentes após a correção cirúrgica.PAlAvrAs-cHAve: cirurgia cardíaca, atraso no desenvolvimento neurológico, teste de Denver II, cardiopatia congênita. corrective cardiac surgery involves a series of complex and high risk procedures and a large number of them expose the brain to hypoxic ischemic insults 1 . Prospective studies have shown that 100% of children who undergo cardiac surgery present with central nervous system dysfunctions in the immediate post-operative period 2 as a consequence of alterations in the cerebral blood flow. If the hypoxic ischemic insult is acute and extensive, the patients may not regain consciousness in the immediate post-operative period and stand increased chances of irreversible sequelae. some of the neurological findings that may be observed are seizures, alterations of consciousness, behavioral disorders, intellectual impairment, focal deficit, involuntary movements, and lesions to the periph-

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“…n eurodevelopmental impairment affects up to one half of all survivors of infant heart surgery, with the spectrum ranging from gross and fine motor deficits, visuospatial difficulties, and impaired cognition to delay in speech and language development (1)(2)(3)(4)(5). The mechanisms contributing to brain injury in infants with congenital heart disease are complex and multifactorial, with no consistent improvement in neurodevelopmental outcomes achieved despite major advances in pediatric cardiac surgery and survival.…”

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confidence: 99%

Impact of levosimendan on brain injury patterns in a lamb model of infant cardiopulmonary bypass

et al. 2014

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Background:The effects of levosimendan (Levo) on injury patterns in the immature brain following cardiopulmonary bypass (CPB) are unknown. Methods: Eighteen 3-to 4-wk-old anesthetized lambs, instrumented with vascular catheters and aortic and right carotid artery flow probes, were allocated to non-CPB, CPB, or CPB+Levo groups (each n = 6). After 120 min CPB with 90 min aortic cross-clamp, CPB animals received dopamine, and CPB+Levo animals both dopamine and Levo, for 4 h. All lambs then underwent brain magnetic resonance imaging, followed by postmortem brain perfusion fixation for immunohistochemical studies. results: In CPB lambs, aortic (P < 0.05) and carotid artery (P < 0.01) blood flows fell by 29 and 30%, respectively, between 2 and 4 h after cross-clamp removal but were unchanged in the CPB+Levo group. No brain injury was detectable with magnetic resonance imaging in either CPB or CPB+Levo lambs. However, on immunohistochemical analysis, white matter astrocyte density of both groups was higher than in non-CPB lambs (P < 0.05), while white matter microglial density was higher (P < 0.05), but markers of cortical oxidative stress were less prevalent in CPB+Levo than CPB lambs. conclusion: While Levo prevented early postoperative falls in cardiac output and carotid artery blood flow in a lamb model of infant CPB, this was associated with heterogeneous neuroglial activation and manifestation of markers of oxidative stress. n eurodevelopmental impairment affects up to one half of all survivors of infant heart surgery, with the spectrum ranging from gross and fine motor deficits, visuospatial difficulties, and impaired cognition to delay in speech and language development (1-5). The mechanisms contributing to brain injury in infants with congenital heart disease are complex and multifactorial, with no consistent improvement in neurodevelopmental outcomes achieved despite major advances in pediatric cardiac surgery and survival. A recent report from the Pediatric Heart Network and the National Heart, Lung, and Blood Institute working group reaffirmed the importance of trials aimed at evaluating novel therapies to address this problem (6).Younger infants undergoing surgery for congenital heart disease are most susceptible to developing brain injury (7,8).The perioperative interval represents a high-risk period with often extended duration of cardiopulmonary bypass (CPB) at the time of the first surgical procedure, as well as significant circulatory disturbance postoperatively. The avoidance of a low cardiac output (CO) state, which can complicate the postoperative course of a proportion of infants after cardiac surgery and which may contribute to later impairment, is a major focus of postoperative care after infant heart surgery. The PRIMACORP study demonstrated the efficacy of intravenous milrinone in preventing this phenomenon in a cohort of children undergoing intracardiac repairs (9). Our laboratory subsequently demonstrated that the inodilator levosimendan (Levo) (Simdax, Abbott, Botany, Australia) was at leas...

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Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial

Cited by 600 publications

References 44 publications

Cerebral Oxygen Metabolism in Neonates with Congenital Heart Disease Quantified by MRI and Optics

Cerebral Oxygen Metabolism in Neonates with Congenital Heart Disease Quantified by MRI and Optics

Neuropsychomotor development before and after open-heart surgery in infants

Impact of levosimendan on brain injury patterns in a lamb model of infant cardiopulmonary bypass

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