Abstract
BACKGROUND AND PURPOSE: A uniform description of brain MR imaging findings in infants with severe congenital heart disease to assess risk factors, predict outcome, and compare centers is lacking. Our objective was to uniformly describe the spectrum of perioperative brain MR imaging findings in infants with congenital heart disease.
MATERIALS AND METHODS: Prospective observational studies were performed at 3 European centers between 2009 and 2019. Brain MR imaging was performed preoperatively and/or postoperatively in infants with transposition of the great arteries, single-ventricle physiology, or left ventricular outflow tract obstruction undergoing cardiac surgery within the first 6 weeks of life. Brain injury was assessed on T1, T2, DWI, SWI, and MRV. A subsample of images was assessed jointly to reach a consensus.
RESULTS: A total of 348 MR imaging scans (180 preoperatively, 168 postoperatively, 146 pre- and postoperatively) were obtained in 202 infants. Preoperative, new postoperative, and cumulative postoperative white matter injury was identified in 25%, 30%, and 36%; arterial ischemic stroke, in 6%, 10%, and 14%; hypoxic-ischemic watershed injury in 2%, 1%, and 1%; intraparenchymal cerebral hemorrhage, in 0%, 4%, and 5%; cerebellar hemorrhage, in 6%, 2%, and 6%; intraventricular hemorrhage, in 14%, 6%, and 13%; subdural hemorrhage, in 29%, 17%, and 29%; and cerebral sinovenous thrombosis, in 0%, 10%, and 10%, respectively.
CONCLUSIONS: A broad spectrum of perioperative brain MR imaging findings was found in infants with severe congenital heart disease. We propose an MR imaging protocol including T1-, T2-, diffusion-, and susceptibility-weighted imaging, and MRV to identify ischemic, hemorrhagic, and thrombotic lesions observed in this patient group.
ABBREVIATIONS:
- AIS
- arterial ischemic stroke
- CHD
- severe congenital heart disease
- CSVT
- cerebral sinovenous thrombosis
- IVH
- intraventricular hemorrhage
- KCL
- St. Thomas’ Hospital London
- LVOTO
- left ventricular outflow tract obstruction
- SVP
- single ventricle physiology
- TGA
- transposition of the great arteries
- UCZ
- University Children’s Hospital Zurich
- WKZ
- Wilhelmina Children’s Hospital Utrecht
- WMI
- white matter injury
Footnotes
R. Stegeman and M. Feldmann shared first authorship.
S.J. Counsell and M.J.N.L. Benders shared last authorship.
Disclosures: Raymond Stegeman—RELATED: Grant: European Society of Pediatric Research Grant, Grant: ZonMw CRUCIAL-TRIAL, Stichting Hartekind*, Comments: Linda de Vries—RELATED: Grant: European Society of Pediatric Research;UNRELATED: Employment: University Medical Centre Utrecht; Payment for Lectures Including Service on Speakers Bureaus, Comments: I teach a cranial ultrasound course every year in London*; Royalties: I am a co-author of 2 books and an associate editor of another book: 1) Govaert P, de Vries L. An Atlas of Neonatal Brain Sonography, 2nd ed. (CDM 182–183), Mac Keith Press. ISBN: 978-1-898683-56-8, July 2010; 2) Hellström-Westas L, de Vries LS, Rosen I. An Atlas of Amplitude-Integrated EEGs in the Newborn. 2nd ed. Informa Health, London; August 2008; ISBN 9781841846491; 3) Inder TE, Darras BT, de Vries LS, de Plessis AJ, Neil JJ, Perlman JM. Volpe’s Neurology of the Newborn. 6th ed.* Walter Knirsch—RELATED: Grant: European Society of Pediatric Research; Support for Travel to Meetings for the Study or Other Purposes, Comments: travel costs. John Simpson—Grant: European Society of Pediatric Research; UNRELATED: Consultancy: Philips Healthcare, Comments: I have undertaken consultant work for Philips related to fetal cardiac imaging, nothing about brain imaging; Payment for Lectures Including Service on Speakers Bureaus: Canon Medical Systems, Comments: I received honorariums for lecturing on fetal cardiology. Christopher J. Kelly—RELATED: Grant: European Society of Pediatric Research, British Heart Foundation.* Sophie Arulkumaran—RELATED: Grant: European Society of Pediatric Research, British Heart Foundation (FS/15/55/31649).* Serena J. Counsell—RELATED: Grant: European Society of Pediatric Research, Medical Research Council Action for Medical Research, British Heart Foundation*; UNRELATED: Consultancy: IXICO Ltd.* Manon Benders—RELATED: Grant: European Society of Pediatric Research, ZonMw CRUCIAL-TRIAL, Stichting Hartekind*; UNRELATED: Consultancy: Chiesi stem cells.* *Money paid to the institution.
This research was funded by a Consolidator Grant of the European Society of Pediatric Research. It was also funded by the Hartekind Foundation and Vrienden van het Wilhelmina Kinderziekenhuis Foundation; the Medical Research Council UK (MR/L011530/1); the British Heart Foundation (FS/15/55/31649); the Action Medical Research (GN2630); the Wellcome Engineering and Physical Sciences Research Council Center for Medical Engineering at King’s College London (WT 203148/Z/16/Z); and the Mäx-iFoundation, the Anna Müller Grocholski Foundation, and the EMDO Foundation Zurich.
Paper previously presented, in part, as abstracts at: Annual Scientific Sessions of the Cardiac Neurodevelopmental Outcome Collaborative, October 11–13, 2019; Toronto, Ontario, Canada; and Congress of the European Academy of Pediatric Societies, October 16–19, 2020; Virtual.
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