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Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of
Insights
Cardiopulmonary bypass (CPB) and hypothermic circulatory arrest can cause temporary brain changes in children. Using membrane oxygenators or finer filters during CPB may reduce these effects.
Area of Science:
- Pediatric Cardiac Surgery
- Neuroimaging
- Cardiovascular Perfusion
Background:
- Cardiopulmonary bypass (CPB) and hypothermic circulatory arrest are critical procedures in pediatric cardiac surgery.
- Potential neurological complications following these interventions warrant careful evaluation.
Purpose of the Study:
- To assess the effects of CPB and hypothermic circulatory arrest on brain morphology in children using computed tomography (CT).
- To investigate the influence of different CPB techniques and filter types on postoperative CT findings.
Main Methods:
- Computed tomography (CT) scans were used to evaluate brain morphology in 57 children undergoing cardiac operations.
- Patients were divided into groups based on CPB (bubble vs. membrane oxygenators) and filter usage, or deep hypothermia with circulatory arrest duration.
Main Results:
- In the bubble oxygenator group, 31% of patients with 40 mu filters or no filters showed decreased brain mass on CT, particularly those with longer perfusion times (>80 minutes).
- No CT changes were observed in patients using membrane oxygenators or in those with 20 mu filters in the arterial line.
- Two infants with circulatory arrest exceeding 60 minutes showed CT changes, which resolved within 6-11 months without clinical manifestation.
Conclusions:
- CPB with bubble oxygenators and larger filters may be associated with transient brain morphology changes in children.
- Deep hypothermia and circulatory arrest exceeding 60 minutes can also lead to temporary CT abnormalities.
- Microemboli or hypoxia are potential causes, suggesting the importance of oxygenator type and filtration in mitigating neurological effects.
Abstract:
Effects of cardiopulmonary bypass (CPB) and hypothermic circulatory arrest on brain morphology were evaluated by computed tomography (CT). Of 57 children undergoing cardiac operations, 45 (4.5 +/- 2.8 years of age) were operated upon with the use of CPB with high-flow, mildly hypothermic perfusions. Twenty-seven of them were perfused with bubble oxygenators and 18 with membrane oxygenators. In the bubble oxygenator group, all 14 with 20 mu filters in the arterial line showed no postoperative CT changes, whereas four of 13 (31%) with 40 mu filters or without filters showed decreases in brain mass on CT scans. Three of these four patients underwent perfusion for more than 80 minutes. There were no CT changes in the membrane oxygenator group. Twelve infants (10.4 +/- 4.5 months of age) were operated upon with the aid of deep hypothermia and circulatory arrest (core temperature below 20 degrees C). Ten of 12 who had circulatory arrest for less than 60 minutes showed no CT changes, but two infants who had circulatory arrest for more than 60 minutes showed changes similar to those described above. All six children with CT changes had no clinical manifestation of the brain damage, and their CT abnormalities recovered within 6 to 11 months after operation. The specific cause of these changes remains undetermined, but microemboli or hypoxia during operation could be implicated.