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Preoperative cerebral blood flow is diminished in neonates with severe congenital heart defects
Open accessAbstract
Objective Impaired neurodevelopmental outcome represents a major morbidity for survivors of infant heart surgery for congenital heart defects. Previous studies in these neonates have reported preoperative microcephaly, periventricular leukomalacia, and other findings. The hypothesis of this study is that preoperative cerebral blood flow is substantially diminished and might relate to preoperative neurologic conditions.Methods Preoperative brain magnetic resonance imaging was performed. Cerebral blood flow measurements in infants with congenital heart defects were obtained by using a novel noninvasive magnetic resonance imaging technique, pulsed arterial spin-label perfusion magnetic resonance imaging. Cerebral blood flow was measured before the operation under standard ventilation and repeated after increased carbon dioxide.Results A total of 25 term infants were studied. The average age at the time of the operation was 4.4 +/- 4.6 days. Congenital heart defects varied widely. Microcephaly occurred in 24% (6/25). Baseline cerebral blood flow was 19.7 +/- 9.2 mL . 100 g -1 . min -1 (8.0-42.2 mL . 100 g -1 . min -1 ). Five patients had cerebral blood flow measurements of less than 10 mL . 100 g -1 . min -1 . Mean hypercarbic cerebral blood flow increased to 40.1 +/- 20.3 mL . 100 g -1 . min -1 (11.4-94.0 mL . 100 g -1 . min -1 , P < .001). Pairwise analyses found that low hemoglobin levels were associated with higher baseline cerebral blood flow values ( P = .04). Periventricular leukomalacia occurred in 28% (7/25) and was associated with decreased baseline cerebral blood flow values ( P = .05) and a smaller change in cerebral blood flow with hypercarbia ( P = .003).Conclusions Structural brain abnormalities are common in these neonates before surgical intervention. Preoperative cerebral blood flow for this cohort was low and drastically reduced in some patients. Low cerebral blood flow values were associated with periventricular leukomalacia. Carbon dioxide reactivity was preserved but might be compromised by some aspects of the cardiac anatomy. The full spectrum of cerebral blood flow measurements with this technique in congenital heart defects and their long-term significance require continued investigation.
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“WMI is associated with periods of acute brain hypoperfusion, as neonatal autoregulatory mechanisms are still immature and lack the ability to cope with haemodynamic fluctuations.19”
From Perioperative neonatal brain injury is associated with worse school-age neurodevelopment in children with critical congenital heart disease (2018) · cites this paper as [19]
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“Studies have documented a high prevalence of peri-operative brain injury and delayed brain development in neonates with CHD (7–10).”
From Neonatal Brain Injury and Timing of Neurodevelopmental Assessment in Patients With Congenital Heart Disease (2018) · cites this paper as [10]
In the citing paper
“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.”
From Brain Volume and Metabolism in Fetuses With Congenital Heart Disease: Evaluation With Quantitative Magnetic Resonance Imaging and Spectroscopy (2010) · cites this paper as [12]
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“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].”
From Brain Volume and Metabolism in Fetuses With Congenital Heart Disease: Evaluation With Quantitative Magnetic Resonance Imaging and Spectroscopy (2010) · cites this paper as [12]
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“Several studies have documented abnormal cerebral blood flow in fetuses and newborns with complex anomalies such as hypoplastic left heart syndrome (HLHS) [12,20,21].”
From Brain Volume and Metabolism in Fetuses With Congenital Heart Disease: Evaluation With Quantitative Magnetic Resonance Imaging and Spectroscopy (2010) · cites this paper as [12]
In the citing paper
“Lower postnatal cerebral blood flow (measured with arterial spin labelling) is associated with higher incidences of preoperative white matter abnormalities in CHD neonates with SVP and TGA.79”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [79]
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Metadata
- Authors
- Licht, D. J., Wang, J., Silvestre, D. W., Nicolson, S. C., Montenegro, L. M., Wernovsky, G., Tabbutt, S., Durning, S. M., Shera, D. M., Gaynor, J. W., Spray, T. L., Clancy, R. R., Zimmerman, R. A., & Detre, J. A.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Hospital of the University of Pennsylvania (US)
- Corresponding author
- Licht, Daniel J.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2004-12
- Volume
- 128
- Issue
- 6
- Pages
- 841-849
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2034628853
- Cited by
- 332
- References
- 29
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 12 · 2023: 15 · 2022: 10 · 2021: 19 · 2020: 12 · 2019: 18 · 2018: 18 · 2017: 18 · 2016: 13 · 2015: 10 · 2014: 17 · 2013: 20 · 2012: 20
- FWCI
- 10.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- W. W. Smith Charitable Trust
- Pfizer
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Cardiovascular Conditions and Treatments
- Keywords
- congenital heart disease, neonates, cerebral blood flow, periventricular leukomalacia, microcephaly, hypercapnia, carbon dioxide reactivity, low hemoglobin, neurodevelopmental outcomes
- MeSH terms
- Brain, Female, Heart Defects, Congenital, Humans, Hypercapnia, Infant, Newborn, Leukomalacia, Periventricular, Magnetic Resonance Imaging, Male, Oxygen, Regional Blood Flow
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