Abstract 16687: Brain Abnormalities Causing Surgical Postponement in Single Ventricle Patients Throughout Staged Surgical Reconstruction
Background: Single ventricle (SV) pts undergoing staged surgical reconstruction experience a high rate of brain injury & structural brain abnormalities. Much research has documented the occurrence of white matter injury & stroke, but there has been no systematic study of brain findings which may alter the timing of surgery.
Methods: We prospectively studied single ventricle (SV) pts with brain magnetic resonance imaging (MRI) immediately prior to surgery & were reviewed at the time of acquisition to determine whether it was safe neurologically to progress to cardiopulmonary bypass surgery.
Results: 192 SV pts were studied: 91 were prior to stage I (3.7+1.8 days), 34 were prior to bidirectional Glenn (5.8+3.5 months) and 67 were prior to Fontan (3.29+1.1 years). 8 (4.2%) surgeries needed to be postponed because of neurological finding on brain MRIs. 4 were prior to stage I, 3 were prior to bidirectional Glenn & 1 was prior to Fontan. 7 delays were due to unexpected intracranial hemorrhage (see figure) & one was due to diffuse cerebellar cytotoxic edema. Risk factors were sought & prematurity as well as genetic syndromes were not present in any pt with postponed surgery. Four of 4 pts in the cohort prior to bidirectional Glenn/Fontan that had surgical delays had hypoplastic left heart syndrome compared with 42/97 who did not have surgical postponement (Chi Square P=0.086) and may not have been significant because of the small numbers. After treatment and observations, all pts eventually went on to have successful surgeries.
Conclusion: Preoperative brain MRIs in infants and children with SV disclosed injuries in 4.2% of pts in whom clinical concern over potential extension lead to delay of surgery. However, the true risk of progression and thus need for delay of surgery associated with these lesions remains uncertain. Additional studies are needed to determine which pts are risk for these lesions and therefore should undergo preoperative MRI.
- © 2012 by American Heart Association, Inc.