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

被引：184
作者：
Petit, Christopher J. [1 ]
Rome, Jonathan J. [1 ]
Wernovsky, Gil [1 ,2 ]
Mason, Stefanie E. [3 ]
Shera, David M. [4 ]
Nicolson, Susan C. [5 ]
Montenegro, Lisa M. [5 ]
Tabbutt, Sarah [1 ,2 ]
Zimmerman, Robert A. [6 ]
Licht, Daniel J. [3 ]
机构：
[1] Childrens Hosp Philadelphia, Div Cardiol, Dept Pediat, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Div Crit Care Med, Dept Anesthesia & Crit Care Med, Philadelphia, PA 19104 USA
[3] Childrens Hosp Philadelphia, Dept Pediat, Div Neurol, Philadelphia, PA 19104 USA
[4] Childrens Hosp Philadelphia, Div Biostat & Epidemiol, Philadelphia, PA 19104 USA
[5] Childrens Hosp Philadelphia, Div Cardiothorac Anesthesia, Dept Anesthesia & Crit Care Med, Philadelphia, PA 19104 USA
[6] Childrens Hosp Philadelphia, Dept Radiol, Philadelphia, PA 19104 USA
来源：
CIRCULATION | 2009年 / 119卷 / 05期
关键词：
heart defects; congenital; oxygen; brain; catheterization; magnetic resonance imaging; CONGENITAL HEART-DISEASE; PERIVENTRICULAR LEUKOMALACIA; CARDIAC-SURGERY; CIRCULATORY ARREST; PRETERM INFANTS; BLOOD-FLOW; NEWBORNS; DEFECTS; CHILDREN;
D O I：
10.1161/CIRCULATIONAHA.107.760819
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
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. (Circulation. 2009; 119: 709-716.)
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收藏
页码：709 / 716
页数：8
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