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Alterations in cerebral ventricle size in children with congenital heart disease
Laurie L Ackerman1, Stephen F Kralik2, Zachary Daniels3
1Department of Neurosurgery, Goodman Campbell Brain and Spine, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
Insights
Children with tetralogy of Fallot (TOF) and superior cavopulmonary anastomoses (SCPA) may develop cerebral ventriculomegaly. Elevated central venous pressure (CVP) after SCPA correlated with increased ventricle size, suggesting a link between CVP and ventriculomegaly in these patients.
Area of Science:
- Pediatric Cardiology
- Neurology
- Congenital Heart Disease
Background:
- Children with tetralogy of Fallot (TOF) and superior cavopulmonary anastomoses (SCPA) often experience chronically elevated central venous pressure (CVP).
- Elevated CVP is a potential risk factor for developing cerebral ventriculomegaly in these pediatric patients.
Purpose of the Study:
- To investigate the relationship between changes in CVP and cerebral ventricle size in children with TOF and SCPA.
- To assess ventricle size before and after surgical repair in patients with these congenital heart conditions.
Main Methods:
- Retrospective review of 44 SCPA and 31 TOF repair patients with pre- and post-operative cranial imaging (2006-2015).
- Calculation of frontal-occipital (FO) horn ratios to measure cerebral ventricle volume.
- Comparison of FO ratios, occipito-fronto circumference (OFC) percentiles, and CVP measurements using statistical tests.
Main Results:
- SCPA patients showed significantly increased FO ratios (0.37 to 0.40) and OFC percentiles post-surgery, alongside elevated CVP (6.5 to 9.1 mmHg).
- TOF patients had persistently elevated FO ratios (0.43 to 0.42) with no significant change post-surgery, and stable CVP (12.9 to 14.4 mmHg).
- A correlation was observed between increased CVP and enlarged ventricles in SCPA patients.
Conclusions:
- Cerebral ventriculomegaly is present in children with SCPA and TOF.
- Changes in FO ratio and OFC in SCPA patients appear linked to elevated CVP.
- CVP may be a contributing factor to ventriculomegaly in pediatric patients with these heart conditions.
Purpose:
Children with tetralogy of Fallot (TOF) and superior cavopulmonary anastomoses (SCPA) can have chronically elevated central venous pressure (CVP), which has been postulated to put patients at risk for cerebral ventriculomegaly. We aimed to examine cerebral ventricle size in children with these congenital heart lesions before and after surgery to determine how changes in CVP affect ventricle size.
Methods:
We reviewed the records of patients who underwent SCPA or TOF repair between 2006 and 2015. Patients with pre- or post-operative cranial imaging were included. Frontal-occipital (FO) horn ratios were calculated as measures of cerebral ventricle volume. Reported normal mean FO ratio is 0.37 ± 0.03. Patient characteristics including occipito-fronto circumference (OFC) and available CVP measurements were recorded. CVP, FO ratios, and OFC percentiles were compared using paired and unpaired t tests and Wilcoxon matched pairs signed-rank test as appropriate.
Results:
We reviewed 44 patients who underwent SCPA and 31 patients who underwent TOF repair who had cranial imaging studies available. In the 22 patients who underwent SCPA and had pre- and post-operative imaging, mean FO ratios significantly increased from 0.37 ± 0.03 to 0.40 ± 0.04 (P < 0.001). In contrast, in the seven patients with TOF with pre- and post-operative imaging, FO ratio was elevated at baseline and remains so after surgical repair, 0.43 ± 0.08 to 0.42 ± 0.08 (P = 0.65). Similar patterns were noted with OFC percentiles, which were significantly increased as compared to baseline after SCPA (P < 0.001) but were not significantly changed after TOF repair (P = 0.58). Finally, when available, preoperative and postoperative CVP measurements of all patients were examined, CVP increased in patients who underwent SCPA, from 6.5 ± 2 mmHg preoperatively to 9.1 ± 2.3 mmHg postoperatively (P < 0.001), while CVP remained statistically unchanged in patients who underwent TOF repair, 12.9 ± 3.3 mmHg preoperatively to 14.4 ± 3.1 mmHg postoperatively (P = 0.2).
Conclusion:
Cerebral ventriculomegaly was observed in patients with SCPA and TOF, and the observed changes in FO ratio and OFC may be related, at least in part, to CVP.
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