New White Matter Brain Injury after Infant Heart Surgery is Associated with Diagnostic Group and the Use of Circulatory Arrest
Background—Abnormalities on magnetic resonance imaging (MRI) scans are common both before and after surgery for congenital heart disease (CHD) in early infancy. The aim of this study was to prospectively investigate the nature, timing and consequences of brain injury on MRI in a cohort of young infants undergoing surgery for CHD both with and without cardiopulmonary bypass (CPB).
Methods and Results—153 infants undergoing surgery for CHD at less than eight weeks of age underwent serial MRI scans before and after surgery and at three months of age and neurodevelopmental assessment at two years of age. White matter injury (WMI) was the commonest type of injury both before and after surgery. It occurred in 20% of infants before surgery and was associated with a less mature brain. New WMI after surgery was present in 44% of infants, and at similar rates after surgery with or without CPB. The most important association was diagnostic group (p<0.001). In infants having arch reconstruction, the use and duration of circulatory arrest was significantly associated with new WMI. New WMI was also associated with the duration of CPB, post-operative lactate level, brain maturity and WMI before surgery. Brain immaturity but not brain injury was associated with impaired neurodevelopment at two years of age.
Conclusions—New WMI is common after surgery for CHD, and occurs at the same rate in infants undergoing surgery with and without CPB. New WMI is associated with diagnostic group and, in infants undergoing arch surgery, the use of circulatory arrest.
- Received January 4, 2013.
- Accepted January 9, 2013.
- Copyright © 2013, Circulation