Elsevier

The Journal of Pediatrics

Volume 167, Issue 5, November 2015, Pages 1018-1024
The Journal of Pediatrics

Original Article
Impaired Global and Regional Cerebral Perfusion in Newborns with Complex Congenital Heart Disease

Portions of the study were presented orally at the meeting of the Radiologic Society of North America, Chicago, IL, December 1, 2013.
https://doi.org/10.1016/j.jpeds.2015.08.004Get rights and content

Objective

To compare global and regional cerebral perfusion in newborns with congenital heart disease (CHD) and healthy controls using arterial spin labeling (ASL) magnetic resonance imaging (MRI) prior to open heart surgery.

Study design

We performed brain MRIs in 101 newborns (58 controls, 43 CHD) using 3-dimensional fast spin echo pseudo-continuous ASL. Cerebral blood flow (CBF) ASL images were linearly coregistered to T2-weighted images for anatomic delineation and selection of regions-of-interest. Anatomic regions included frontal white matter (FWM), occipital white matter (OWM), thalami, and basal ganglia (BG).

Results

Newborns with single ventricle CHD demonstrated significantly lower global (P = .044) and regional BG (P = .025) CBF compared with controls. Mean regional CBF in the thalami in cyanotic newborns with CHD was lower compared with controls (P = .004). Mean regional CBF in thalami (P = .02), BG (P = .01), and OWM (P = .03) among newborns with cyanotic CHD was lower than those with acyanotic CHD. Newborns with CHD ventilated prior to MRI had increased global (P = .016) and OWM (P = .013) CBF compared with those not ventilated.

Conclusions

Newborns with uncorrected cyanotic or single ventricle CHD show disturbances in cerebral perfusion compared to healthy controls using ASL. Cardiac physiology and preoperative hemodynamic compromise play an important role in preoperative alterations in global and regional cerebral perfusion. Our data suggest that ASL may be useful for studying cerebral perfusion in newborns at high risk for cerebral ischemia, such as those with complex CHD.

Section snippets

Methods

As part of a prospective observational study, we recruited newborns with complex CHD prior to open-heart surgery, as well as healthy newborn controls at Children's National Medical Center in Washington, DC. Normal controls were recruited from healthy pregnant volunteers, and cases were recruited from pregnant mothers with fetal CHD confirmed by neonatal echocardiography. Exclusion criteria for both cases and controls included contraindication to newborn MRI, multiple-gestation pregnancy,

Results

A total of 101 newborns with diagnostic quality ASL images (58 controls, 43 CHD) were included in the study. Studies from an additional 8 patients were excluded because of nondiagnostic quality ASL images. Baseline characteristics of the excluded subjects were not different from those included (n = 101) in the analysis. The clinical characteristics of our cohort are summarized in Table I.

Labor and delivery characteristics are summarized in Table II. The frequency of maternal medical conditions

Discussion

In this study we used ASL MRI to compare CBF between newborns with uncorrected CHD and healthy controls. First, we demonstrate that global and regional perfusion in the BG was significantly reduced in single-ventricle CHD vs controls. Next, we demonstrate that newborns with cyanotic CHD had lower mean CBF in the thalami vs controls. Finally, we demonstrate that newborns with CHD that were previously ventilated, have a CPR <1, or have prenatal aortic arch obstruction show increased global and

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    Funded by the Canadian Institutes of Health Research (MOP-81116 [to C.L.]). The authors declare no conflicts of interest.

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