Preoperative cranial ultrasound findings in infants with major congenital heart disease

Pas, Arjan B. te; Wezel‐Meijler, Gerda van; Bökenkamp-Gramann, Regina; Walther, Frans J.

doi:10.1080/08035250510041150

Cited by 16 publications

(22 citation statements)

References 27 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there is increasing evidence that adverse neurodevelopmental outcomes in children with complex CHD are due not only perioperative insult, but to inborn factors as well. Reports from a number of investigators have documented a high prevalence of anatomic and functional neurologic abnormalities prior to surgery in newborns with CHD [9-17], and an association of such abnormalities with childhood developmental status [11,13,18,19]. These findings support the hypothesis that abnormal brain development and growth in utero contribute to adverse neurodevelopmental outcomes in children with CHD.…”

Section: Introductionmentioning

confidence: 56%

Brain Volume and Metabolism in Fetuses With Congenital Heart Disease

et al. 2010

View full text Add to dashboard Cite

Background-Adverse neurodevelopmental outcome is an important source of morbidity in children with congenital heart disease (CHD). A significant proportion of newborns with complex CHD have abnormalities of brain size, structure, or function, which suggests that antenatal factors may contribute to childhood neurodevelopmental morbidity. Methods and Results-Brain volume and metabolism were compared prospectively between 55 fetuses with CHD and 50 normal fetuses with the use of 3-dimensinal volumetric magnetic resonance imaging and proton magnetic resonance spectroscopy. Fetal intracranial cavity volume, cerebrospinal fluid volume, and total brain volume were measured by manual segmentation. Proton magnetic resonance spectroscopy was used to measure the cerebral N-acetyl aspartate: choline ratio (NAA:choline) and identify cerebral lactate. Complete fetal echocardiograms were performed. Gestational age at magnetic resonance imaging ranged from 25 1 ⁄7 to 37 1 ⁄7 weeks (median, 30 weeks). During the third trimester, there were progressive and significant declines in gestational age-adjusted total brain volume and intracranial cavity volume in CHD fetuses relative to controls. NAA:choline increased progressively over the third trimester in normal fetuses, but the rate of rise was significantly slower (PϽ0.001) in CHD fetuses. On multivariable analysis adjusted for gestational age and weight percentile, cardiac diagnosis and percentage of combined ventricular output through the aortic valve were independently associated with total brain volume. Independent predictors of lower NAA:choline included diagnosis, absence of antegrade aortic arch flow, and evidence of cerebral lactate (PϽ0.001). Conclusions-Third-trimester fetuses with some forms of CHD have smaller gestational age-and weight-adjusted total brain volumes than normal fetuses and evidence of impaired neuroaxonal development and metabolism. Hemodynamic factors may play an important role in this abnormal development. (Circulation. 2010;121:26-33.)

show abstract

Section: Introductionmentioning

confidence: 56%

Brain Volume and Metabolism in Fetuses With Congenital Heart Disease

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Preoperative head ultrasounds can detect abnormality in 15–59% of patients with congenital heart disease [9, 11, 12]. Brain magnetic resonance imaging (MRI) performed prior to surgery also demonstrates a high incidence of preoperative brain abnormalities ranging from 25–53% in some series [13–15].…”

Section: Preoperative Neurological Status In Babies With Chdmentioning

confidence: 99%

“…In a study by Limperopoulos, preoperative evaluation of babies with CHD excluding HLHS revealed microcephaly in 36% and macrocephaly in 13% of babies evaluated [7]. Head ultrasound has detected abnormality in patients with CHD including cerebral atrophy [11], echodensities or calcifications in the basal ganglia [11, 12], and widened ventricular or subarachnoid spaces [9, 12, 52, 53]. …”

Section: Preoperative Neurological Status In Babies With Chdmentioning

confidence: 99%

Impact of Congenital Heart Disease on Brain Development and Neurodevelopmental Outcome

Donofrio

Massaro

2010

International Journal of Pediatrics

111

115

View full text Add to dashboard Cite

Advances in cardiac surgical techniques and perioperative intensive care have led to improved survival in babies with congenital heart disease (CHD). While it is true that the majority of children with CHD today will survive, many will have impaired neurodevelopmental outcome across a wide spectrum of domains. While continuing to improve short-term morbidity and mortality is an important goal, recent and ongoing research has focused on defining the impact of CHD on brain development, minimizing postnatal brain injury, and improving long-term outcomes. This paper will review the impact that CHD has on the developing brain of the fetus and infant. Neurologic abnormalities detectable prior to surgery will be described. Potential etiologies of these findings will be discussed, including altered fetal intrauterine growth, cerebral blood flow and brain development, associated congenital brain abnormalities, and risk for postnatal brain injury. Finally, reported neurodevelopmental outcomes after surgical repair of CHD will be reviewed.

show abstract

“…There is growing evidence that neurodevelopmental anomalies in the setting of congenital heart disease may be due not only to perioperative insult but also to impaired brain growth and development prenatally (Hinton et al, 2008, Limperopoulos et al, 2000, Mahle et al, 2002, Miller et al, 2007 and Te Pas et al, 2005). Among the various types of congenital heart disease, hypoplastic left heart syndrome (HLHS) appears to carry a particularly high risk of abnormal neurodevelopmental outcome (Goldberg et al, 2000, Hinton et al, 2008, Ikle et al, 2003, Mahle and Wernovsky, 2004 and Wernovsky et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Cerebral Blood Flow Characteristics and Biometry in Fetuses Undergoing Prenatal Intervention for Aortic Stenosis with Evolving Hypoplastic Left Heart Syndrome

McElhinney

Benson

Brown

et al. 2010

Ultrasound in Medicine & Biology

View full text Add to dashboard Cite

Children with hypoplastic left heart syndrome (HLHS) are at risk for neurodevelopmental dysfunction; prenatal factors may play a role in this predilection. Cerebral blood flow profiles are abnormal in fetuses with HLHS, raising the possibility that cerebral hemodynamics in utero may be related to neurodevelopmental abnormalities. Prenatal aortic valvuloplasty for fetal aortic stenosis with evolving HLHS is technically feasible and improves left heart hemodynamics. This study aimed to assess the effects of prenatal intervention on cerebral blood flow profiles and head circumference in fetuses with evolving HLHS. Seventy fetuses underwent prenatal aortic valvuloplasty for evolving HLHS (median 23 weeks gestation). Among 46 fetuses that had successful valvuloplasty and available data, middle cerebral artery (MCA) pulsatility (PI) and resistive (RI) indices were abnormal (Z-scores −1.7 ± 1.1 and −2.2 ± 1.4, p < 0.001). Early post-valvuloplasty (n = 33) and at late gestation follow-up (n = 28), MCA PI and RI Z-scores remained low with no difference from pre- or early postintervention. Fetal head circumference was normal, as were umbilical artery PI and RI Z-scores. Cerebral blood flow characteristics are abnormal in mid-gestation fetuses with evolving HLHS, suggesting low cerebral vascular impedance. The mechanisms and significance of these abnormalities are unknown. Prenatal aortic valvuloplasty did not have a major impact on these indices.

show abstract

Preoperative cranial ultrasound findings in infants with major congenital heart disease

Abstract: There is a high incidence of preoperative cerebral ultrasound abnormalities in this group of neonates with major CHD.

Cited by 16 publications

References 27 publications

Brain Volume and Metabolism in Fetuses With Congenital Heart Disease

Brain Volume and Metabolism in Fetuses With Congenital Heart Disease

Impact of Congenital Heart Disease on Brain Development and Neurodevelopmental Outcome

Cerebral Blood Flow Characteristics and Biometry in Fetuses Undergoing Prenatal Intervention for Aortic Stenosis with Evolving Hypoplastic Left Heart Syndrome

Contact Info

Product

Resources

About