Original ArticleImpaired Global and Regional Cerebral Perfusion in Newborns with Complex Congenital Heart Disease
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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Long-Term Neurodevelopmental Outcomes of Children with Congenital Heart Defects
2021, Journal of PediatricsArterial spin labeling perfusion in neonates
2020, Seminars in Fetal and Neonatal MedicineCitation Excerpt :However, only few studies have used ASL to explore the effects of CHD on brain perfusion before surgery [45–47]. Most of these studies are concordant in showing global and regional hypoperfusion patterns, more severe in neonates with cyanotic or single ventricle CHD [45,46]. In particular, Nagaraj et al. demonstrated that regional perfusion is significantly reduced in the basal ganglia in single-ventricle CHD and in the thalami in cyanotic CHD.
Abnormalities in cerebral hemodynamics and changes with surgical intervention in neonates with congenital heart disease
2020, Journal of Thoracic and Cardiovascular SurgeryPostoperative cerebral oxygenation was not associated with new brain injury in infants with congenital heart disease
2019, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :In addition, SVP showed less time with COR 0.5 or greater (sign of impaired CA) with increasing etCO2. Two previous studies reported increased cerebral blood flow and autoregulatory capacity in ventilated infants when compared with nonventilated infants with CHD because of higher CO2 levels.10,30 Increased CO2 causes arterial cerebral vasodilatation, increasing cerebral blood supply, and subsequently cerebral oxygen delivery.
Cortical Dysmaturation in Congenital Heart Disease
2019, Trends in NeurosciencesCitation Excerpt :Interestingly, lower cerebrovascular resistance in fetuses with single ventricle anomalies is associated with impairments in early neurological development [46]. Finally, an arterial spin-labeling MRI study found significant decreases in global cerebral blood flow in newborns with complex CHD, which suggests limitations in oxygen and nutrient delivery [42]. Cerebral oxygenation is another crucial factor in brain development in the perinatal period.
Funded by the Canadian Institutes of Health Research (MOP-81116 [to C.L.]). The authors declare no conflicts of interest.