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Updated: Aug 23, 2026
Mouse Models of Periventricular Leukomalacia
Published on: May 18, 2010
Periventricular leukomalacia following neonatal and infant cardiac surgery
1Division of Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Congenital heart defect surgery can cause brain injury, particularly periventricular leukomalacia (PVL) in neonates. This neurological issue requires further study to understand its long-term impact on child development.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Neonatal Surgery
Background:
- Congenital heart defect (CHD) repair has reduced surgical mortality.
- However, neurodevelopmental sequelae, including cognitive and language deficits, are increasingly recognized in children post-surgery.
- Central nervous system (CNS) injury is a key concern.
Purpose of the Study:
- To investigate the incidence and risk factors of periventricular leukomalacia (PVL) in infants undergoing cardiac surgery.
- To explore the potential link between PVL and long-term neurodevelopmental outcomes.
Main Methods:
- Retrospective analysis of infants undergoing cardiac surgery.
- Assessment of neuroimaging for PVL, focusing on neonates versus older infants.
- Identification of risk factors including cardiopulmonary bypass duration, hypothermia, hypotension, and hypoxemia.
Main Results:
- Periventricular leukomalacia (PVL) occurs in over 50% of neonates following cardiac surgery, but is rare in older infants.
- Prolonged cardiopulmonary bypass and postoperative hypotension (especially diastolic) are significant risk factors for PVL.
- Systemic inflammatory response to cardiopulmonary bypass may contribute to PVL.
Conclusions:
- Neonatal cardiac surgery is associated with a high incidence of PVL, a type of white matter injury.
- Understanding PVL's significance as a marker for long-term developmental dysfunction is crucial.
- Further research is needed to establish the long-term neurodevelopmental impact of PVL in this population.
Abstract:
The dramatic reduction in surgical mortality following repair of congenital heart defects has been accompanied by increasing recognition of adverse neurodevelopmental sequelae in some children. Neurodevelopmental abnormalities following neonatal and infant cardiac surgery include mild cognitive impairment, expressive speech and language abnormalities, impaired attention and executive function, impaired visual and spatial motor skills, as well as learning disabilities. These defects result in a significant need for early intervention, as well as rehabilitative and special education services. Central nervous system injury following repair of congenital heart defects results from a complex interaction of patient specific and environmental factors. Recent studies suggest that cerebral white matter injury characterized by periventricular leukomalacia (PVL) is common in infants with congenital heart disease particularly following cardiac surgery. Studies at our institution show that this occurs in greater than 50% of neonates following cardiac surgery, but is rare in older infants. Prolonged exposure to cardiopulmonary bypass (with or without deep hypothermic circulatory arrest) is a risk factor for PVL, possibly secondary to the systemic inflammatory response to cardiopulmonary bypass. Hypotension and hypoxemia in the early postoperative period, especially diastolic hypotension, significantly increase the risk of PVL. Future studies are needed to determine significance of PVL as a marker for long-term developmental dysfunction.
