This Article Full Text Full Text (PDF) All Versions of this Article: 119/5/709    most recent CIRCULATIONAHA.107.760819v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Petit, C. J. Articles by Licht, D. J. Search for Related Content PubMed PubMed Citation Articles by Petit, C. J. Articles by Licht, D. J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB OXYGEN Related Collections Pediatric and congenital heart disease, including cardiovascular surgery Computerized tomography and Magnetic Resonance Imaging Stroke in Children and the Young Related Article

(Circulation. 2009;119:709-716.)
© 2009 American Heart Association, Inc.

Pediatric Cardiology

Preoperative Brain Injury in Transposition of the Great Arteries Is Associated With Oxygenation and Time to Surgery, Not Balloon Atrial Septostomy

Christopher J. Petit, MD; Jonathan J. Rome, MD; Gil Wernovsky, MD; Stefanie E. Mason, BS; David M. Shera, ScD; Susan C. Nicolson, MD; Lisa M. Montenegro, MD; Sarah Tabbutt, MD, PhD; Robert A. Zimmerman, MD; Daniel J. Licht, MD

From the Division of Cardiology, Department of Pediatrics (C.J.P., J.J.R., G.W., S.T.); Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine (G.W., S.T.); Division of Neurology, Department of Pediatrics (S.E.M., D.J.L.); Division of Biostatistics and Epidemiology (D.M.S.); Division of Cardiothoracic Anesthesia, Department of Anesthesia and Critical Care Medicine (S.C.N., L.M.M.); and Department of Radiology (R.A.Z.), The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.

Correspondence to Christopher J. Petit, MD, Texas Children’s Hospital, 6621 Fannin St, MC-19345 C, Houston, TX 77030. E-mail cjpetit{at}texaschildrenshospital.org

Received December 20, 2007; accepted November 14, 2008.

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.

---

 

CLINICAL PERSPECTIVE

Related Article:

Circulation: Clinical Summaries
Circulation 2009 119: 649-651. [Extract] [Full Text]

This article has been cited by other articles:

				P. S. McQuillen Magnetic Resonance Imaging in Congenital Heart Disease: What to Do With What We See and Don't See? Circulation, February 10, 2009; 119(5): 660 - 662. [Full Text] [PDF]