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Preoperative Brain Injury in Transposition of the Great Arteries Is Associated With Oxygenation and Time to Surgery, Not Balloon Atrial Septostomy
Open accessAbstract
Background— Preoperative brain injury is an increasingly recognized phenomenon in neonates with complex congenital heart disease. Recently, reports have been published that associate preoperative brain injury in neonates with transposition of the great arteries with the performance of balloon atrial septostomy (BAS), a procedure that improves systemic oxygenation preoperatively. It is unclear whether BAS is the cause of brain injury or is a confounder, because neonates who require BAS are typically more hypoxemic. We sought to determine the relationship between preoperative brain injury in neonates with transposition of the great arteries and the performance of BAS. We hypothesized that brain injury results from hypoxic injury, not from the BAS itself. Methods and Results— Infants with transposition of the great arteries (n=26) were retrospectively included from a larger cohort of infants with congenital heart disease who underwent preoperative brain MRI as part of 2 separate prospective studies. Data collected included all preoperative pulse oximetry recordings, all values from preoperative arterial blood gas measurements, and BAS procedure data. MRI scans were performed on the day of surgery, before the surgical repair. Of the 26 neonates, 14 underwent BAS. No stroke was seen in the entire cohort, whereas 10 (38%) of 26 patients were found to have hypoxic brain injury in the form of periventricular leukomalacia. Periventricular leukomalacia was not associated with BAS; however, neonates with periventricular leukomalacia had lower preoperative oxygenation ( P =0.026) and a longer time to surgery ( P =0.028) than those without periventricular leukomalacia. Conclusions— Preoperative brain injury in neonates with transposition of the great arteries is associated with hypoxemia and longer time to surgery. We found no association between BAS and brain injury.
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“Consistent with this, we observed a trend towards earlier surgery in the antenatal diagnosis group, which has been associated with reduced preoperative brain injury, more rapid postoperative brain growth, and improved neurodevelopmental outcomes in infants with TGA, possibly through improved oxygenation and hemodynamics.9,21”
From Antenatal diagnosis, neonatal brain volumes, and neurodevelopment in transposition of the great arteries (2024) · cites this paper as [21]
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In the citing paper
“Preoperative hypotension and lower preoperative oxygen saturations have been associated with an increased risk of brain injury in infants with CHD.21,25,26”
From Antenatal diagnosis, neonatal brain volumes, and neurodevelopment in transposition of the great arteries (2024) · cites this paper as [21]
Experimental — accuracy not yet measuredIn the citing paper
“The results of 2 studies have suggested that earlier repair might be neuroprotective in TGA.12,13”
From Associations Between Age at Arterial Switch Operation, Brain Growth, and Development in Infants With Transposition of the Great Arteries (2019) · cites this paper as [13]
In the citing paper
“Previous studies in newborns with TGA and hypoplastic left heart syndrome have demonstrated an increased risk of white matter injury with increasing intervals between birth and surgery.13,33”
From Associations Between Age at Arterial Switch Operation, Brain Growth, and Development in Infants With Transposition of the Great Arteries (2019) · cites this paper as [13]
In the citing paper
“Longer waiting times between birth and surgery are associated with higher rates of both pre-and postoperative brain injury, although the reasons why surgery was postponed (postnatal diagnosis, haemodynamic instability) should be taken into account when interpreting this finding.80,84”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [80]
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Metadata
- Authors
- Petit, C. J., Rome, J. J., Wernovsky, G., Mason, S. E., Shera, D. M., Nicolson, S. C., Montenegro, L. M., Tabbutt, S., Zimmerman, R. A., & Licht, D. J.
- Affiliations
- Children's Hospital of Philadelphia (US)
- ORCID
- Venue
- Circulation
- Published
- 2009-02-10
- Volume
- 119
- Issue
- 5
- Pages
- 709-716
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2736632
- OpenAlex
- W2120976691
- Cited by
- 282
- References
- 30
- Citations by year
- 2026: 20 · 2025: 13 · 2024: 17 · 2023: 22 · 2022: 17 · 2021: 14 · 2020: 17 · 2019: 13 · 2018: 20 · 2017: 16 · 2016: 10 · 2015: 9 · 2014: 21 · 2013: 24 · 2012: 13
- FWCI
- 10.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (K23NS052380)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Cardiovascular Conditions and Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- transposition of the great arteries, neonates, balloon atrial septostomy, periventricular leukomalacia, hypoxemia, systemic oxygenation, time to surgery, congenital heart disease
- MeSH terms
- Catheterization, Hypoxia, Brain, Female, Gestational Age, Heart Atria, Heart Septal Defects, Atrial, Heart Septal Defects, Ventricular, Heart Septum, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Oxygen, Preoperative Care, Retrospective Studies, Risk Factors, Transposition of Great Vessels, Logistic Models, Stroke
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