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Long-term MRI changes in brain after pediatric open heart surgery
G Miller1, A C Mamourian, J R Tesman
1Section of Pediatric Neurology, Baylor College of Medicine, Texas Children's Hospital, Houston 77030.
Insights
Brain imaging in children after open heart surgery revealed frequent abnormalities. Prolonged hypothermic circulatory arrest during early infancy significantly increased the risk of diffuse brain injury and neurodevelopmental issues.
Area of Science:
- Pediatric Neurology
- Cardiovascular Surgery
- Neuroimaging
Background:
- Congenital heart disease (CHD) often requires surgical intervention in infancy.
- The impact of open heart surgery on neurodevelopment in children is a significant concern.
- Magnetic resonance imaging (MRI) is crucial for assessing brain structure and potential injury.
Purpose of the Study:
- To investigate the neuroimaging findings and neurodevelopmental outcomes in children following open heart surgery for CHD.
- To identify risk factors associated with brain abnormalities after surgery.
- To correlate MRI findings with neurologic and psychometric assessments.
Main Methods:
- Performed brain MRI and neurologic examinations on 23 children post-open heart surgery for CHD.
- Conducted psychometric assessments on 20 children.
- Analyzed MRI findings for diffuse abnormalities, cortical infarction, and other structural anomalies.
- Correlated findings with age at operation, duration of hypothermic circulatory arrest, and neurodevelopmental outcomes.
Main Results:
- Seventeen out of 23 children (74%) showed abnormal MRI scans.
- Abnormalities included hypoxic-ischemic encephalopathy, cortical infarction, callosal agenesis, and neuronal migration disorders.
- Diffuse brain abnormalities were associated with prolonged hypothermic circulatory arrest and early infancy surgery, leading to cerebral palsy and mental retardation.
- Focal cortical lesions without diffuse changes were more common in older infants without circulatory arrest and had fewer neurodevelopmental sequelae.
Conclusions:
- Focal cortical lesions are common after open heart surgery in children with CHD.
- Diffuse brain abnormalities and subsequent neurologic sequelae are strongly linked to prolonged hypothermic circulatory arrest and early infant surgery.
- Neuroimaging plays a vital role in understanding the spectrum of brain injury in this population.
Abstract:
We performed magnetic resonance imaging (MRI) on the brain and neurologic examinations on 23 children after open heart surgery for congenital heart disease. Twenty children also had psychometric assessments. Examinations were performed at a mean age of 66 months (range, 26 to 180 months). Age at operation was less than 1 month in 43% and more than 6 months in 45%. Abnormal scans were found in 17 (74%) and showed diffuse findings consistent with hypoxic-ischemic encephalopathy, with or without areas of cortical infarction; focal cortical infarction alone; and (in one patient) callosal agenesis and abnormal neuronal migration. Normal IQ and neurologic examinations were found in all six of those who had a normal MRI, and five of six children with changes consistent with focal cortical infarction without diffuse change had a normal neurologic examination. Cerebral palsy and mental retardation was common in the group with diffuse abnormality (in eight of nine children), and this was more likely to occur in those who underwent prolonged (> 45 minutes) hypothermic circulatory arrest and operation during early infancy (P = .004). Focal cortical findings without diffuse changes were more likely in those who underwent open heart surgery without hypothermic circulatory arrest and were older than 6 months at operation, and these children were less likely to have frank neurodevelopmental sequelae. Thus, in our population, focal cortical lesions were common after open heart surgery, and, in addition, diffuse brain abnormality on MRI plus neurologic sequelae were common after prolonged hypothermic circulatory arrest.