Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries
Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries
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DOI：
10.1161/circulationaha.105.566752
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发表时间：
2006-01-17
期刊：
影响因子：
37.8
通讯作者：
Miller, SP
中科院分区：
文献类型：
--
作者：
McQuillen, PS;Hamrick, SEG;Miller, SP
背景--术前脑损伤在大动脉转位的新生儿中很常见.本研究的目的是确定术前脑损伤的危险因素与新生儿TGA。方法和结果-二十九个足月新生儿TGA进行了研究与MRI心脏手术前的前瞻性队列研究。12例患者（41%）术前MRI显示有脑损伤，所有损伤均为局灶性或多灶性。所有患者均无出生窒息。19名患者（66%）需要术前球囊房间隔造口术（BAS）。所有脑损伤患者均患有BAS（19例中的12例;风险差异，63%; 95%置信区间，41至85; P = 0.001）。根据BAS的需要，这些新生儿的全身动脉血红蛋白饱和度（SaO（2））较低（P = 0.05）。损伤的风险没有修改的插管部位为中隔造口术（脐与股，P = 0.8）或存在的中心静脉导管（P = 0.4）。结论-BAS是一个主要的可识别的危险因素术前局灶性脑损伤新生儿TGA。确定的脑损伤的影像学特征与栓塞一致;然而，其机制比BAS的血管通路部位或暴露于中心静脉导管更复杂。这些发现对BAS的适应症、手术修复的时机和TGA中抗凝剂的使用具有意义。
Background - Preoperative brain injury is common in neonates with transposition of the great arteries (TGA). The objective of this study is to determine risk factors for preoperative brain injury in neonates with TGA.Methods and Results - Twenty-nine term neonates with TGA were studied with MRI before cardiac surgery in a prospective cohort study. Twelve patients (41%) had brain injury on preoperative MRI, and all injuries were focal or multifocal. None of the patients had birth asphyxia. Nineteen patients (66%) required preoperative balloon atrial septostomy (BAS). All patients with brain injury had BAS ( 12 of 19; risk difference, 63%; 95% confidence interval, 41 to 85; P = 0.001). As expected on the basis of the need for BAS, these neonates had lower systemic arterial hemoglobin saturation (SaO(2)) ( P = 0.05). The risk of injury was not modified by the cannulation site for septostomy ( umbilical versus femoral, P = 0.8) or by the presence of a central venous catheter ( P = 0.4).Conclusions - BAS is a major identifiable risk factor for preoperative focal brain injury in neonates with TGA. Imaging characteristics of identified brain injuries were consistent with embolism; however, the mechanism is more complex than site of vascular access for BAS or exposure to central venous catheters. These findings have implications for the indications for BAS, timing of surgical repair, and use of anticoagulation in TGA.