| Clinically silent preoperative brain injuries do not worsen with surgery in neonates with congenital heart disease. | |
| | |
MedLine Citation:
|
PMID: 20434174 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: Preoperative brain injury, particularly stroke and white matter injury, is common in neonates with congenital heart disease. The objective of this study was to determine the risk of hemorrhage or extension of preoperative brain injury with cardiac surgery. METHODS: This dual-center prospective cohort study recruited 92 term neonates, 62 with transposition of the great arteries and 30 with single ventricle physiology, from 2 tertiary referral centers. Neonates underwent brain magnetic resonance imaging scans before and after cardiac surgery. RESULTS: Brain injury was identified in 40 (43%) neonates on the preoperative magnetic resonance imaging scan (median 5 days after birth): stroke in 23, white matter injury in 21, and intraventricular hemorrhage in 7. None of the brain lesions presented clinically with overt signs or seizures. Preoperative brain injury was associated with balloon atrial septostomy (P = .003) and lowest arterial oxygen saturation (P = .007); in a multivariable model, only the effect of balloon atrial septostomy remained significant when adjusting for lowest arterial oxygen saturation. On postoperative magnetic resonance imaging in 78 neonates (median 21 days after birth), none of the preoperative lesions showed evidence of extension or hemorrhagic transformation (0/40 [95% confidence interval: 0%-7%]). The presence of preoperative brain injury was not a significant risk factor for acquiring new injury on postoperative magnetic resonance imaging (P = .8). CONCLUSIONS: Clinically silent brain injuries identified preoperatively in neonates with congenital heart disease, including stroke, have a low risk of progression with surgery and cardiopulmonary bypass and should therefore not delay clinically indicated cardiac surgery. In this multicenter cohort, balloon atrial septostomy remains an important risk factor for preoperative brain injury, particularly stroke. |
| | |
Authors:
|
A J Block; P S McQuillen; V Chau; H Glass; K J Poskitt; A J Barkovich; M Esch; W Soulikias; A Azakie; A Campbell; S P Miller |
Related Documents
:
|
10738894 - Stress fracture of the cuboid in an 8-year-old boy: a characteristic magnetic resonance... 15085474 - Magnetic resonance imaging of the elbow. 16496144 - Forearm interosseous membrane trauma: mri diagnostic criteria and injury patterns. 11482474 - Non-union of the capitate with associated triangular fibrocartilage tear. 10503624 - A magnetic bearing system for a continuous ventricular assist device. 10607954 - Knobloch syndrome involving midline scalp defect of the frontal region. |
Publication Detail:
|
Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Sep |
Date Detail:
|
Created Date: 2010-08-20 Completed Date: 2010-09-20 Revised Date: 2011-09-13 |
Medline Journal Info:
|
Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 550-7 Citation Subset: AIM; IM |
Copyright Information:
|
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
|
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Balloon Dilation
/
adverse effects Brain / pathology* British Columbia Cardiac Surgical Procedures* / adverse effects Disease Progression Female Heart Defects, Congenital / blood, complications, surgery* Humans Infant, Newborn Intracranial Hemorrhages / blood, complications*, pathology Logistic Models Magnetic Resonance Imaging Male Oxygen / blood Prospective Studies Risk Assessment Risk Factors San Francisco Stroke / blood, complications*, pathology Time Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
|
5-M01-RR-01271/RR/NCRR NIH HHS; 93780//Canadian Institutes of Health Research; M01 RR001271-230377/RR/NCRR NIH HHS; M01 RR001271-240377/RR/NCRR NIH HHS; P50 NS035902-13/NS/NINDS NIH HHS; P50 NS35902/NS/NINDS NIH HHS; R01 NS063876-01A2/NS/NINDS NIH HHS; R01 NS40117/NS/NINDS NIH HHS; R01NS063876/NS/NINDS NIH HHS |
| Chemical | |
Reg. No./Substance:
|
7782-44-7/Oxygen |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experien...
Next Document: Comparative effects of norepinephrine and vasopressin on internal thoracic arterial graft flow after...