Cerebral lesions on magnetic resonance imaging correlate with preoperative neurological status in neonates undergoing cardiopulmonary bypass surgery
Open accessAbstract
OBJECTIVES: To determine the prevalence, spectrum and course of cerebral lesions in neonates with congenital heart disease (CHD) undergoing full flow cardiopulmonary bypass (CPB) surgery using magnetic resonance imaging (MRI) and to examine the correlation between cerebral lesions and clinical neurological abnormalities. METHODS: Prospective cohort study of neonates with d-transposition of the great arteries (n = 22), univentricular heart malformation with hypoplastic aortic arch (n = 6) and aortic arch obstructions (n = 2) undergoing CPB. Neonates underwent cerebral MRI and blinded standardized neurological examination before (median day 6) and after surgery (day 13). The MRI findings were compared with those of 20 healthy controls. RESULTS: Preoperative cerebral lesions were present in 7 of 30 patients (23%) with isolated mild or moderate white matter injury (WMI) (n = 4), isolated small cerebral stroke (n = 1) and combined WMI and stroke (n = 2). None of the healthy controls had cerebral lesions on MRI. CHD neonates with preoperative cerebral lesions had more neurological abnormalities (P = 0.01) than neonates without cerebral lesions. Low arterial oxygen saturation (P = 0.03) was a risk factor for preoperative cerebral lesions, while balloon atrioseptostomy (P = 0.19) was not. After surgery, preoperative cerebral lesions persisted in 5 of 7 neonates, and 2 neonates (7%) showed signs of additional WMI in their postoperative MRI. CONCLUSIONS: In neonates with severe CHD, WMI was the predominant preoperative finding, while cerebral strokes were less frequent. New postoperative lesions were rare. Preoperative neurological abnormalities correlated with the presence of cerebral lesions on MRI.
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Lower preoperative oxygen saturation and preoperative hypotension are associated with increased risk of preoperative white matter injury, as is postnatal diagnosis of the heart defect.
“Accordingly, lower preoperative oxygen saturation and preoperative hypotension are also associated with increased risk of preoperative WMI, 72,74,77,80 as is postnatal diagnosis of the heart defect.59”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [77]
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“HL, QY, and YW scanned the participants by MRI.”
BackgroundInfluential
- Authors
- Bertholdt, S., Latal, B., Liamlahi, R., Pretre, R., Scheer, I., Goetti, R., Dave, H., Bernet, V., Schmitz, A., von Rhein, M., Knirsch, W., & on behalf of the Research Group Heart and Brain
- Affiliations
- University Children's Hospital Zurich (CH)
- University of Zurich (CH)
- Corresponding author
- Knirsch, W.
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-09-12
- Volume
- 45
- Issue
- 4
- Pages
- 625-632
- ISSN
- 1010-7940 (ISSN-L)
- 1873-734X
- OpenAlex
- W2116447029
- Cited by
- 64
- References
- 26
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 6 · 2019: 10 · 2018: 1 · 2017: 7 · 2016: 5 · 2015: 5 · 2014: 1
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Cardio-Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- EMDO Stiftung
- Universitätsspital Zürich
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- neonatal cardiopulmonary bypass, congenital heart disease, brain lesions, white matter injury, neonatal stroke, transposition of the great arteries, aortic arch hypoplasia, aortic arch obstruction, preoperative neurological status, arterial oxygen saturation, postoperative neurological outcome
- MeSH terms
- Cardiopulmonary Bypass, Cerebral Cortex, Female, Heart Defects, Congenital, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Prospective Studies, Cohort Studies, Case-Control Studies, Treatment Outcome, Stroke, Preoperative Period
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