Original article: cardiovascularPreoperative brain injury in newborns with transposition of the great arteries☆
Section snippets
Patients
Ten consecutive newborns with TGA and intact ventricular septum, or small restrictive ventricular septal defects, born in or transferred to our institution since September 2001 were studied with preoperative and postoperative MRI and MRSI. Newborns were excluded from the study if gestational age at birth was less than 36 weeks, if there was clinical evidence of a congenital malformation or syndrome, or if there was congenital infection. If a balloon atrial septostomy was clinically indicated,
Clinical and MRI characteristics
The clinical characteristics of the three groups, historical controls, TGA newborns without preoperative brain injury, and TGA newborns with preoperative brain injury, including perinatal and preoperative cardiac indices, were similar (Table 1). All newborns with TGA underwent an arterial switch operation with full-flow CPB, without deep hypothermic circulatory arrest or low-flow CPB. The intraoperative and postoperative indices of the TGA newborns with and without preoperative brain injury
Brain injury occurs preoperatively in infants with TGA
Using preoperative and postoperative MRI and MRSI in hemodynamically stable newborns with TGA, we found preoperative brain injury on MRI in 4 of 10 patients. This is consistent with the observation that more than half of newborns with CHD have evidence of neurobehavioral and neurologic abnormalities before surgery 2, 9. We also found a high incidence of abnormalities on preoperative neurologic examination, including abnormalities of tone and reflexes. The focal lesions identified on
Acknowledgements
The authors thank Dr George Gregory and the neonatal nurses of the Pediatric Clinical Research Center (PCRC) for their expertise, and gratefully acknowledge the assistance of Mary Ann Bohland and Srivathsa Veeraraghavan in acquiring and processing the MR data. This research is supported by the Larry L. Hillblom Foundation (Start-Up Grant) and the American Heart Association (Beginning Grant-In-Aid 0365018Y; SPM), the Pediatric Clinical Research Center at UCSF (National Institutes of Health
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*These authors contributed equally to this manuscript.