Abstract 19890: Pre-operative Cerebral Hemodynamics From Birth Until Surgery in Neonates With Critical Congenital Heart Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jennifer M Lynch ◽  
John J Newland ◽  
Madeline Winters ◽  
David R Busch ◽  
Ann L McCarthy ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
White Matter ◽  
Congenital Heart ◽  
White Matter Injury ◽  
Therapeutic Interventions ◽  
Metabolic Demand ◽  
Critical Congenital Heart Disease ◽  
Therapeutic Algorithms ◽  
Increased Risk

Introduction: Neonates with critical congenital heart disease (CHD) exhibit a high prevalence of white matter injury (WMI). Recent work in neonates with hypoplastic left heart syndrome has shown that a longer wait from birth to surgery was associated with lower cerebral tissue oxygen saturations (StO2) on the morning of surgery and an increased risk for postoperative white matter injury (WMI). Understanding the daily preoperative changes in cerebral physiology during this vulnerable period may lead to new therapeutic algorithms aimed at prevention of WMI. Methods: Term neonates with critical CHD were recruited for this study. Frequency domain diffuse optical spectroscopy was employed to noninvasively quantify StO2. Daily StO2 measurements were made from day of recruitment until the day of surgery. Results: We studied 37 neonates with critical CHD. Operations were performed at 1-8 days of life. Non-elective reasons for timing of surgery resulted only in earlier surgery in this cohort. The subjects were placed in 2 groups depending on if they had a normal arch (N=20) or obstructed arch (N=17). In a linear mixed-effects model, StO2 decreased as a function of time from birth but was not specific to diagnostic group. Conclusions: Observed longitudinal daily decline in StO2 from birth until surgery supports our earlier findings and extends them to other groups of CHD. These results suggest that reported increases in risk for WMI with time-to-surgery could be due to mismatched oxygen delivery to metabolic demand. Therapeutic interventions such as increasing cerebral blood flow or decreasing cerebral oxygen demand may be considered when earlier surgery is not possible.

scholarly journals Early detection of and intervention for two newborns with critical congenital heart disease using a specialized device as part of a screening system

2020 ◽  
Vol 8 ◽  
pp. 2050313X2092604
Author(s):  
René Gómez-Gutiérrez ◽  
Héctor Cruz-Camino ◽  
Consuelo Cantú-Reyna ◽  
Adrián Martínez-Cervantes ◽  
Diana Laura Vazquez-Cantu ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Early Detection ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Screening Program ◽  
Disease Screening ◽  
Therapeutic Interventions ◽  
Critical Congenital Heart Disease ◽  
Clinical Method

Screening for critical congenital heart disease is a clinical method used for their early detection using pulse oximetry technology. This, followed by a diagnostic confirmatory protocol, allows timely therapeutic interventions that improve the newborn’s outcome. According to Mexican birth statistics, approximately 18,000–21,000 neonates are born with a form of congenital heart disease each year, of which 25% are estimated to be critical congenital heart disease. We report two cases with an early critical congenital heart disease detection and intervention through an innovative critical congenital heart disease screening program implemented in two Mexican hospitals. They integrated a new automated pulse oximetry data analysis method and a comprehensive follow-up system (Cárdi-k®). Both cases were confirmed by echocardiogram, which served for an intervention in the first week of life, and the patients were discharged in good clinical condition. In addition, to the routine physical assessments, the critical congenital heart disease screening program (which includes echocardiogram for presumptive positive cases) should be implemented in a timely manner.

scholarly journals Delayed maturation of the structural brain connectome in neonates with congenital heart disease

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Maria Feldmann ◽  
Ting Guo ◽  
Steven P Miller ◽  
Walter Knirsch ◽  
Raimund Kottke ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
White Matter ◽  
Congenital Heart ◽  
White Matter Injury ◽  
Network Development ◽  
Brain Connectome ◽  
Structural Network ◽  
Term Newborns ◽  
Structural Brain

Abstract There is emerging evidence for delayed brain development in neonates with congenital heart disease. We hypothesize that the perioperative development of the structural brain connectome is a proxy to such delays. Therefore, we set out to quantify the alterations and longitudinal pre- to post-operative changes in the connectome in congenital heart disease neonates relative to healthy term newborns and assess factors contributing to disturbed perioperative network development. In this prospective cohort study, 114 term neonates with congenital heart disease underwent cardiac surgery at the University Children’s Hospital Zurich. Forty-six healthy term newborns were included as controls. Pre- and post-operative structural connectomes were derived from mean fractional anisotropy values of fibre pathways traced using diffusion MR tractography. Graph theory parameters calculated across a proportional cost threshold range were compared between groups by multi-threshold permutation correction adjusting for confounders. Network-based statistic was calculated for edgewise network comparison. White-matter injury volume was quantified on 3D T1-weighted images. Random coefficient mixed models with interaction terms of (i) cardiac subtype and (ii) injury volume with post-menstrual age at MRI, respectively, were built to assess modifying effects on network development. Pre- and post-operatively, at the global level, efficiency, indicative of network integration, was lower in heart disease neonates than controls. In contrast, local efficiency and transitivity, indicative of network segregation, were higher compared to controls (all P < 0.025 for one-sided t-tests). Pre-operatively, these group differences were also found across multiple widespread nodes (all P < 0.025, accounting for multiple comparison), whereas post-operatively nodal differences were not evident. At the edge-level, the majority of weaker connections in heart disease neonates compared to controls involved inter-hemispheric connections (66.7% pre-operatively; 54.5% post-operatively). A trend showing a more rapid pre- to post-operative decrease in local efficiency was found in class I cardiac sub-type (biventricular defect without aortic arch obstruction) compared to controls. In congenital heart disease neonates, larger white-matter injury volume was associated with lower strength (P = 0.0026) and global efficiency (P = 0.0097). The maturation of the structural connectome is delayed in congenital heart disease neonates, with a pattern of lower structural integration and higher segregation compared to controls. Trend-level evidence indicated that normalized post-operative cardiac physiology in class I sub-types might improve structural network topology. In contrast, the burden of white-matter injury negatively impacts network strength and integration. Further research is needed to elucidate how aberrant structural network development in congenital heart disease represents neural correlates of later neurodevelopmental impairments.

scholarly journals The importance of small for gestational age in the risk assessment of infants with critical congenital heart disease

2013 ◽  
Vol 23 (6) ◽  
pp. 896-904 ◽  
Author(s):  
Anthony A. Sochet ◽  
Mark Ayers ◽  
Emilio Quezada ◽  
Katherine Braley ◽  
Jennifer Leshko ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Congenital Heart ◽  
Surgical Intervention ◽  
Critical Congenital Heart Disease ◽  
Foetal Growth Restriction ◽  
Increased Risk ◽  
Appropriate For Gestational Age

AbstractBackgroundInfants with critical congenital heart disease who require cardiothoracic surgical intervention may have significant post-operative mortality and morbidity. Infants who are small for gestational age <10th percentile with foetal growth restriction may have end-organ dysfunction that may predispose them to increased morbidity or mortality.MethodsA single-institution retrospective review was performed in 230 infants with congenital heart disease who had cardiothoracic surgical intervention <60 days of age. Pre-, peri-, and post-operative morbidity and mortality markers were collected along with demographics and anthropometric measurements.ResultsThere were 230 infants, 57 (23.3%) small for gestational age and 173 (70.6%) appropriate for gestational age. No significant difference was noted in pre-operative markers – gestational age, age at surgery, corrected gestational age, Society for Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality score; or post-operative factors – length of stay, ventilation days, arrhythmias, need for extracorporeal membrane oxygenation, vocal cord dysfunction, hearing loss; or end-organ dysfunction – gastro-intestinal, renal, central nervous system, or genetic. Small for gestational age infants were more likely to have failed vision tests (p = 0.006). Small for gestational age infants were more likely to have increased 30-day (p = 0.005) and discharge mortality (p = 0.035). Small for gestational age infants with normal birth weight (>2500 g) were also at increased risk of 30-day mortality compared with appropriate for gestational age infants (p = 0.045).ConclusionsSmall for gestational age infants with congenital heart disease who undergo cardiothoracic surgery <60 days of age have increased risk of mortality and failed vision screening. Assessment of foetal growth restriction as part of routine pre-operative screening may be beneficial.

scholarly journals Neuroimaging findings in newborns with congenital heart disease prior to surgery: an observational study

2019 ◽  
Vol 104 (11) ◽  
pp. 1042-1048 ◽  
Author(s):  
Christopher J Kelly ◽  
Sophie Arulkumaran ◽  
Catarina Tristão Pereira ◽  
Lucilio Cordero-Grande ◽  
Emer J Hughes ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
White Matter ◽  
Observational Study ◽  
Congenital Heart ◽  
Brain Mri ◽  
Brain Lesions ◽  
Cerebral Injury ◽  
White Matter Injury ◽  
Cerebellar Haemorrhage

ObjectivesNeurodevelopmental impairment has become the most important comorbidity in infants with congenital heart disease (CHD). We aimed to (1) investigate the burden of brain lesions in infants with CHD prior to surgery and (2) explore clinical factors associated with injury.Study designProspective observational study.SettingSingle centre UK tertiary neonatal intensive care unit.Patients70 newborn infants with critical or serious CHD underwent brain MRI prior to surgery.Main outcome measuresPrevalence of cerebral injury including arterial ischaemic strokes (AIS), white matter injury (WMI) and intracranial haemorrhage.ResultsBrain lesions were observed in 39% of subjects (95% CI 28% to 50%). WMI was identified in 33% (95% CI 23% to 45%), subdural haemorrhage without mass effect in 33% (95% CI 23% to 45%), cerebellar haemorrhage in 9% (95% CI 4% to 18%) and AIS in 4% (95% CI 1.5% to 12%). WMI was distributed widely throughout the brain, particularly involving the frontal white matter, optic radiations and corona radiata. WMI exhibited restricted diffusion in 48% of cases. AIS was only observed in infants with transposition of the great arteries (TGA) who had previously undergone balloon atrial septostomy (BAS). AIS was identified in 23% (95% CI 8% to 50%) of infants with TGA who underwent BAS, compared with 0% (95% CI 0% to 20%) who did not.ConclusionsCerebral injury in newborns with CHD prior to surgery is common.

scholarly journals White Matter Injury in Newborns With Congenital Heart Disease: A Diffusion Tensor Imaging Study

2014 ◽  
Vol 51 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Sarah B. Mulkey ◽  
Xiawei Ou ◽  
Raghu H. Ramakrishnaiah ◽  
Charles M. Glasier ◽  
Christopher J. Swearingen ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Congenital Heart ◽  
Diffusion Tensor ◽  
Imaging Study ◽  
White Matter Injury ◽  
Diffusion Tensor Imaging Study

scholarly journals Pulse Oximetry Screening Has Not Changed Timing of Diagnosis or Mortality of Critical Congenital Heart Disease

2020 ◽  
Vol 41 (5) ◽  
pp. 899-904 ◽  
Author(s):  
Matthew J. Campbell ◽  
William O. Quarshie ◽  
Jennifer Faerber ◽  
David J. Goldberg ◽  
Christopher E. Mascio ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Critical Congenital Heart Disease ◽  
Pulse Oximetry Screening

A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport

2017 ◽  
Vol 24 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Christopher A Rouse ◽  
Brandon T Woods ◽  
C Becket Mahnke
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
The United States ◽  
Critical Congenital Heart Disease ◽  
Medical Centers ◽  
Prompt Diagnosis ◽  
Patent Ductus

Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii. Results During the study period 100 infants received 192 tele-echocardiograms: 46% of infants had tele-echocardiograms completed for suspected patent ductus arteriosus, 28% for suspected congenital heart disease, 12% for possible congenital heart disease in the setting of likely pulmonary hypertension, and 10% for possible congenital heart disease in the setting of other congenital anomalies. Of these, 17 patients were aeromedically evacuated for cardiac reasons; 12 patients were transported to Hawaii, while five patients with complex heart disease were transported directly to the United States mainland for interventional cardiac capabilities not available in Hawaii. Discussion This study demonstrates the use of tele-echocardiography to guide treatment, reduce long and potentially risky trans-Pacific transports, and triage transports to destination centers with the most appropriate cardiac capabilities.

Sign in / Sign up

Export Citation Format

Share Document