Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 6, December 2010, Pages 1996-2000
The Annals of Thoracic Surgery

Original article
Pediatric cardiac
Changes of Brain Magnetic Resonance Imaging Findings After Congenital Aortic Arch Anomaly Repair Using Regional Cerebral Perfusion in Neonates and Young Infants

https://doi.org/10.1016/j.athoracsur.2010.07.038Get rights and content

Background

The objective of this prospective study is to compare magnetic resonance imaging (MRI) findings before and after surgery for repairing congenital aortic arch anomalies using regional cerebral perfusion.

Methods

Neurologic examinations that included brain MRI, brain sonography, and electroencephalograms were performed before and after surgery for congenital aortic arch anomalies and the accompanying intracardiac anomalies using regional cerebral perfusion in 11 neonates and young infants.

Results

The median age at operation was 11 days (range, 5 to 46). The diagnoses included coarctation of the aorta with accompanying intracardiac anomalies (n = 10) and interruption of the aortic arch (n = 1). Aortic arch repair was performed using regional cerebral perfusion through the right innominate artery (regional perfusion time: 25.6 ± 6.0 minutes) without cardiac arrest. Two patients had new postoperative lesions on postoperative brain MRI, and these were acute focal subdural hemorrhage (n = 1) and acute focal infarction (n = 1). However, they were without clinical significance. Periventricular leukomalacia was not observed on brain MRI. There was no significant change between the preoperative and postoperative findings on brain sonography and electroencephalograms. All the patients showed normal neurologic growth for a mean follow-up duration of 175.3 days (range: 25 to 497 days).

Conclusions

There were newly developed lesions on the postoperative brain MRI in 2 of 11 patients, even though these patients showed normal brain sonography and electroencephalogram findings and normal neurologic development. Our regional cerebral perfusion protocol for aortic arch repair showed tolerable neurologic outcomes, and it did not induce periventricular leukomalacia.

Section snippets

Patients and Methods

From May 2008 to August 2009, 11 neonates (9 younger than 30 days) and young infants (n = 2, aged 38 days and 40 days) who underwent surgical repair of congenital aortic arch anomalies and their concomitant intracardiac anomalies were enrolled in this prospective study. The University Ethics Committee reviewed and approved this study (approval number H-0803-043-238), and fully informed written consent regarding the preoperative and postoperative neurologic study and evaluation, the

Patient Profile and Surgical Outcomes

The median age of the patients at the time of operation was 11 days (range: 5 to 46 days), the median body weight was 3.72 kg (range: 2.43 to 4.4 kg), and the body surface area was 0.23 m2 (range: 0.17 to 0.26 m2). The number of male patients was 10. The diagnoses included CoA with ventricular septal defect, atrial septal defect or atrioventricular septal defect (n = 7), CoA with supramitral ring (n = 1), CoA with Taussig-Bing anomaly (n = 1), interrupted aortic arch with ventricular septal

Comment

There are various causes of unexpected adverse neurologic outcomes after cardiac surgery in neonates and young infants. There are nonmodifiable factors such as genetic syndromes, but there are also modifiable factors such as perioperative hypoxic or ischemic insults, and intraoperative situations, including deep hypothermic total circulatory arrest [5]. The advances in CPB techniques, the myocardial protection protocols, and the surgical techniques and instruments have overcome these modifiable

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