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      Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study

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          Abstract

          Objectives

          Neurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.

          Study design

          Prospective observational study.

          Setting

          Single centre UK tertiary neonatal intensive care unit.

          Patients

          70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.

          Main outcome measures

          Prevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.

          Results

          Brain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.

          Conclusions

          Cerebral injury in newborns with CHD prior to surgery is common.

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          Most cited references52

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          MRtrix: Diffusion tractography in crossing fiber regions

          J-Donald Tournier, Fernando Calamante, Alan Connelly (2012)
          Article 0 comments Cited 471 times – based on 0 reviews     Review now
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            The incidence of congenital heart disease.

            Julien Hoffman, Samuel Kaplan (2002)
            This study was designed to determine the reasons for the variability of the incidence of congenital heart disease (CHD), estimate its true value and provide data about the incidence of specific major forms of CHD. The incidence of CHD in different studies varies from about 4/1,000 to 50/1,000 live births. The relative frequency of different major forms of CHD also differs greatly from study to study. In addition, another 20/1,000 live births have bicuspid aortic valves, isolated anomalous lobar pulmonary veins or a silent patent ductus arteriosus. The incidences reported in 62 studies published after 1955 were examined. Attention was paid to the ways in which the studies were conducted, with special reference to the increased use of echocardiography in the neonatal nursery. The total incidence of CHD was related to the relative frequency of ventricular septal defects (VSDs), the most common type of CHD. The incidences of individual major forms of CHD were determined from 44 studies. The incidence of CHD depends primarily on the number of small VSDs included in the series, and this number in turn depends upon how early the diagnosis is made. If major forms of CHD are stratified into trivial, moderate and severe categories, the variation in incidence depends mainly on the number of trivial lesions included. The incidence of moderate and severe forms of CHD is about 6/1,000 live births (19/1,000 live births if the potentially serious bicuspid aortic valve is included), and of all forms increases to 75/1,000 live births if tiny muscular VSDs present at birth and other trivial lesions are included. Given the causes of variation, there is no evidence for differences in incidence in different countries or times.
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              Abnormal brain development in newborns with congenital heart disease.

              Natalie Charlton, Michael Glidden, Duan Xu … (2007)
              Congenital heart disease in newborns is associated with global impairment in development. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease before they underwent heart surgery. We studied 41 term newborns with congenital heart disease--29 who had transposition of the great arteries and 12 who had single-ventricle physiology--with the use of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before cardiac surgery. We calculated the ratio of N-acetylaspartate to choline (which increases with brain maturation), the ratio of lactate to choline (which decreases with maturation), average diffusivity (which decreases with maturation), and fractional anisotropy of white-matter tracts (which increases with maturation). We compared these findings with those in 16 control newborns of a similar gestational age. As compared with control newborns, those with congenital heart disease had a decrease of 10% in the ratio of N-acetylaspartate to choline (P=0.003), an increase of 28% in the ratio of lactate to choline (P=0.08), an increase of 4% in average diffusivity (P<0.001), and a decrease of 12% in white-matter fractional anisotropy (P<0.001). Preoperative brain injury, as seen on MRI, was not significantly associated with findings on MRS or DTI. White-matter injury was observed in 13 newborns with congenital heart disease (32%) and in no control newborns. Term newborns with congenital heart disease have widespread brain abnormalities before they undergo cardiac surgery. The imaging findings in such newborns are similar to those in premature newborns and may reflect abnormal brain development in utero. Copyright 2007 Massachusetts Medical Society.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 0372434
                Journal ID (nlm-ta): Arch Dis Child
                Journal ID (iso-abbrev): Arch. Dis. Child.
                Title: Archives of disease in childhood
                ISSN (Print): 0003-9888
                ISSN (Electronic): 1468-2044
                Publication date (Print): 26 June 2019
                Publication date (Electronic): 26 June 2019
                Publication date Nihms-submitted: 03 September 2019
                Publication date PMC-release: 01 November 2019
                Volume: 104
                Issue: 11
                Pages: 1042-1048
                Affiliations
                [1 ]Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
                [2 ]School of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
                [3 ]Paediatric Cardiology Department, Evelina London Children’s Healthcare, London, UK
                [4 ]Congenital Heart Disease, Evelina London Children’s Hospital, London, London, UK
                Author notes
                Correspondence to: Professor Mary A Rutherford, Centre for the Developing Brain, School of Imaging Sciences and Biomedical Engineering, King’s College London, London WC2R 2LS, UK; mary.rutherford@ 123456kcl.ac.uk
                Article
                Manuscript ID: EMS84277
                DOI: 10.1136/archdischild-2018-314822
                PMC ID: 6801127
                PubMed ID: 31243012
                SO-VID: 9d5ae00c-15a7-49bf-9495-d0877ed6efae
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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                ScienceOpen disciplines: Medicine

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