Preoperative brain injury in newborns with transposition of the great arteries
Preoperative brain injury in newborns with transposition of the great arteries
复制标题
DOI：
10.1016/j.athoracsur.2003.10.084
复制
发表时间：
2004-05-01
影响因子：
4.6
通讯作者：
Karl, TR
中科院分区：
文献类型：
--
作者：
Miller, SP;McQuillen, PS;Karl, TR
背景。目的是利用全流量体外循环修复大动脉转位（TGA）新生儿术前和术后磁共振成像（MRI）和三维磁共振波谱成像（MRSI）确定脑损伤的时间和机制。方法。对 10 名接受动脉调转手术的 TGA 足月新生儿进行了术前和术后的 MRI、MRSI 和神经系统检查，中位年龄分别为 5 天（2 至 9 天）和 19 天（14 至 26 天）。五个期限的历史对照的研究中位数为 4 天（3 至 9 天）。从基底节、丘脑和皮质脊髓束双侧测量乳酸/胆碱（脑氧化代谢标志物）和 N-乙酰天冬氨酸 (NAA)/胆碱（脑代谢和密度标志物）。 结果。 4 名 TGA 新生儿在术前 MRI 上有脑损伤。术后研究中检测到的唯一新病变是一名术前 MRI 正常的新生儿的局灶性白质病变。与无心脏病的新生儿相比，患有 TGA 的新生儿的年龄调整乳酸/胆碱 MRSI 在数量上更高 (P < 0.0001)，即使是在没有术前脑损伤 MRI 证据的新生儿中也是如此。手术后乳酸/胆碱下降，但与对照组相比仍保持升高。在患有 TGA 的新生儿中，MRI 显示术前脑损伤的新生儿总体 NAA/胆碱水平低于术前 MRI 正常的新生儿 (p = 0.04)。从术前到术后研究，五名新生儿的 NAA/胆碱有所下降。结论。 TGA新生儿术前观察到脑代谢异常和损伤。脑损伤不仅仅与手术过程有关。
Background. The objective was to determine the timing and mechanism of brain injury using preoperative and postoperative magnetic resonance imaging (MRI) and three-dimensional MR spectroscopic imaging (MRSI) in newborns with transposition of the great arteries (TGA) repaired with full-flow cardiopulmonary bypass.Methods. Ten term newborns with TGA undergoing an arterial switch operation were studied with MRI, MRSI, and neurologic examination preoperatively and postoperatively at a median of 5 days (2 to 9 days) and 19 days (14 to 26 days) of age, respectively. Five term historical controls were studied at a median of 4 days (3 to 9 days). Lactate/choline (marker of cerebral oxidative metabolism) and N-acetylaspartate (NAA)/choline (marker of cerebral metabolism and density) were measured bilaterally from the basal ganglia, thalamus, and corticospinal tracts.Results. Four TGA newborns had brain injury on the preoperative MRI. The only new lesion detected on the postoperative study was a focal white matter lesion in one newborn with a normal preoperative MRI. The MRSI of age-adjusted lactate/choline was quantitatively higher in newborns with TGA compared with those without heart disease (P < 0.0001), even in newborns without MRI evidence of preoperative brain injury. Lactate/choline decreased after surgery but remained elevated compared with controls. In newborns with TGA, those with preoperative brain injury on MRI had lower NAA/choline globally (p = 0.04) than those with normal preoperative MRI. Five newborns had a decline in NAA/ choline from the preoperative to postoperative studies.Conclusions. Abnormal brain metabolism and injury was observed preoperatively in newborns with TGA. Brain injury is not solely related to the operative course.