An MRI Study of Neurological Injury Before and After Congenital Heart Surgery
Abstract
Background Neuorological deficits are observed in patients with congenital heart disease (CHD) before and after neonatal surgery, the etiology being multifactorial. To understand the impact of preoperative events and to characterize the evaluation of neurological injury, we performed serial magnetic resonance imaging (MRI) studies of the brain in a cohort of neonates undergoing open-heart surgery. Methods and Results Twenty-four term neonates with CHD were studied prospectively with brain MRI: before surgery, within 2 weeks of surgery, and several months after surgery. Preoperative MRI examinations showed periventricular leukomalacia (PVL) in 4 patients (16%) and infarct in 2 subjects (8%). MR spectroscopy was performed in 19 subjects preoperatively and revealed elevated brain lactate in 53%. An early postoperative MRI (n=21) identified new PVL in 48%, new infarct in 19%, and new parenchymal hemorrhage in 33%. New lesions or worsening of preoperative lesions occurred in 67% of subjects. No patient- or procedure-related factors for the development of early postoperative lesions were identified. A late postoperative MRI (n=17) demonstrated resolution of early lesions in 8 and mild cerebral atrophy in 2. Conclusions Mild ischemic lesions, primarily in the form of PVL, occur in a number of neonates with CHD before surgery and >50% of patients postoperatively. Resolution of these lesions is common 4 to 6 months after surgery. Longer-term follow-up is needed to determine the significance of perioperative ischemic lesions on functional outcome.
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A high prevalence of anatomic and functional neurologic abnormalities has been documented before surgery in newborns with congenital heart disease, and such abnormalities are associated with childhood developmental status.
“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 [14]
Adverse neurodevelopmental outcomes in children with complex congenital heart disease are due not only to perioperative insult but also to inborn factors.
“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 [14]
Cerebral lactate is a marker of anaerobic metabolism in the newborn and fetus, has been found in up to 50% of preoperative infants with congenital heart disease, and is associated with adverse outcome in other high-risk infants.
“Cerebral lactate, a marker of anaerobic metabolism in the newborn and fetus [38,39], has been found in up to 50% of preoperative infants with CHD [14,15] and is associated with adverse outcome in other high-risk infants [40].”
From Brain Volume and Metabolism in Fetuses With Congenital Heart Disease: Evaluation With Quantitative Magnetic Resonance Imaging and Spectroscopy (2010) · cites this paper as [14]
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Mulkey, S. B., Swearingen, C. J., Melguizo, M. S., Schmitz, M. L., Ou, X., Ramakrishnaiah, R. H., Glasier, C. M., Bradley Schaefer, G., & Bhutta, A. T. (2013) · Pediatric Cardiology · doi:10.1007/s00246-013-0712-6 · Cited by 34 · see citing works
Scoring system for periventricular leukomalacia in infants with congenital heart disease
McCarthy, A. L., Winters, M. E., Busch, D. R., Gonzalez-Giraldo, E., Ko, T. S., Lynch, J. M., Schwab, P. J., Xiao, R., Buckley, E. M., Vossough, A., et al. (2015) · Pediatric Research · doi:10.1038/pr.2015.99 · Cited by 25 · see citing works
Makki, M., Scheer, I., Hagmann, C., Liamlahi, R., Knirsch, W., Dave, H., Bernet, V., Batinic, K., & Latal, B. (2013) · American Journal of Neuroradiology · doi:10.3174/ajnr.a3256 · Cited by 10 · see citing works
Impact of structural cerebral damage in adults with tetralogy of fallot
Sluman, M. A., Richard, E., Bouma, B. J., van Dalen, J. W., van Wanrooij, L. L., Groenink, M., Caan, M. W. A., Nederveen, A. J., Mutsaerts, H.-J. M. M., Majoie, C. B. L. M., et al. (2017) · Circulation · doi:10.1161/circulationaha.117.027865 · Cited by 7 · see citing works
- Authors
- Mahle, W. T., Tavani, F., Zimmerman, R. A., Nicolson, S. C., Galli, K. K., Gaynor, J. W., Clancy, R. R., Montenegro, L. M., Spray, T. L., Chiavacci, R. M., Wernovsky, G., & Kurth, C. D.
- Affiliations
- Children's Hospital of Philadelphia (US)
- ORCID
- Venue
- Circulation
- Published
- 2002-09-24
- Volume
- 106
- Issue
- 12_suppl_1
- Pages
- I109-14
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1902838673
- Cited by
- 541
- References
- 27
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 15 · 2023: 24 · 2022: 20 · 2021: 21 · 2020: 14 · 2019: 30 · 2018: 24 · 2017: 32 · 2016: 27 · 2015: 24 · 2014: 34 · 2013: 41 · 2012: 34
- FWCI
- 9.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- congenital heart disease, neonatal cardiac surgery, periventricular leukomalacia, cerebral infarction, parenchymal hemorrhage, brain lactate, MR spectroscopy, lesion resolution, brain atrophy
- MeSH terms
- Brain, Brain Chemistry, Cardiopulmonary Bypass, Cerebral Infarction, Cerebrovascular Disorders, Female, Heart Defects, Congenital, Humans, Infant, Newborn, Leukomalacia, Periventricular, Magnetic Resonance Imaging, Male, Magnetic Resonance Spectroscopy, Time Factors, Cohort Studies, Lactic Acid
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