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(Circulation. 2002;106:I-109.)
© 2002 American Heart Association, Inc.

Surgery for Congenital Heart Disease

An MRI Study of Neurological Injury Before and After Congenital Heart Surgery

William T. Mahle, MD; Federica Tavani, MD; Robert A. Zimmerman, MD; Susan C. Nicolson, MD; Kristin K. Galli, MD; J. William Gaynor, MD; Robert R. Clancy, MD; Lisa M. Montenegro, MD; Thomas L. Spray, MD; Rosetta M. Chiavacci, BSN; Gil Wernovsky, MD; C. Dean Kurth, MD

From the Department of Pediatrics, Division of Cardiology (W.M., G.W.), the Division of Neurology (R.R.C.), the Department of Anesthesia and Critical Care Medicine (S.C.N., K.G., L.M.M., R.C., C.D.K.), the Department of Surgery, Division of Cardiothoracic Surgery (J.W.G., T.L.S.), and the Department of Radiology (R.A.Z.), The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Penn., and the Department of Neuroradiology, University of Modena, Modena, Italy (F.T.).

Correspondence to William T. Mahle, MD, Children’s Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Rd., NE, Atlanta, GA 30322-1062. E-mail wmahle{at}emory.edu

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.

Key Words: magnetic resonance imaging • heart defects, congenital