Preoperative brain injury in transposition of the great arteries is associated with oxygenation and time to surgery, not balloon atrial septostomy.
Preoperative brain injury in transposition of the great arteries is associated with oxygenation and time to surgery, not balloon atrial septostomy.
复制标题
DOI：
10.1161/circulationaha.107.760819
复制
发表时间：
2009-02-10
期刊：
影响因子：
37.8
通讯作者：
Licht DJ
中科院分区：
文献类型：
--
作者：
Petit CJ;Rome JJ;Wernovsky G;Mason SE;Shera DM;Nicolson SC;Montenegro LM;Tabbutt S;Zimmerman RA;Licht DJ
术前脑损伤是一个越来越多的认识到的现象，新生儿复杂的先天性心脏病。最近，有报道称，术前大动脉转位的新生儿脑损伤与球囊房间隔造口术（BAS）有关，这是一种改善术前全身氧合的手术。目前尚不清楚BAS是脑损伤的原因还是一个混杂因素，因为需要BAS的新生儿通常更低氧。我们试图确定大动脉转位新生儿术前脑损伤与BAS表现之间的关系。我们假设脑损伤是由缺氧损伤引起的，而不是由BAS本身引起的。大动脉转位婴儿（n=26）回顾性纳入了一组较大的先天性心脏病婴儿队列，这些婴儿术前接受了脑部MRI检查，作为两项独立前瞻性研究的一部分。收集的数据包括所有术前脉搏血氧仪记录、所有术前动脉血气测量值和BAS程序数据。在手术修复之前，在手术当天进行了核磁共振扫描。26例新生儿中，14例接受了BAS。在整个队列中未见卒中，而26例患者中有10例（38%）被发现有室性周围白质软化形式的缺氧脑损伤。脑室周围白质软化与BAS无关；然而，与没有脑室周围白质软化的新生儿相比，有脑室周围白质软化的新生儿术前氧合水平较低（P=0.026），手术时间较长（P=0.028）。新生儿大动脉转位的术前脑损伤与低氧血症和较长的手术时间有关。我们没有发现BAS和脑损伤之间的联系。
Preoperative brain injury is an increasingly recognized phenomenon in neonates with complex congenital heart disease. Recently, reports have been published that associate preoperative brain injury in neonates with transposition of the great arteries with the performance of balloon atrial septostomy (BAS), a procedure that improves systemic oxygenation preoperatively. It is unclear whether BAS is the cause of brain injury or is a confounder, because neonates who require BAS are typically more hypoxemic. We sought to determine the relationship between preoperative brain injury in neonates with transposition of the great arteries and the performance of BAS. We hypothesized that brain injury results from hypoxic injury, not from the BAS itself. Infants with transposition of the great arteries (n=26) were retrospectively included from a larger cohort of infants with congenital heart disease who underwent preoperative brain MRI as part of 2 separate prospective studies. Data collected included all preoperative pulse oximetry recordings, all values from preoperative arterial blood gas measurements, and BAS procedure data. MRI scans were performed on the day of surgery, before the surgical repair. Of the 26 neonates, 14 underwent BAS. No stroke was seen in the entire cohort, whereas 10 (38%) of 26 patients were found to have hypoxic brain injury in the form of periventricular leukomalacia. Periventricular leukomalacia was not associated with BAS; however, neonates with periventricular leukomalacia had lower preoperative oxygenation (P=0.026) and a longer time to surgery (P=0.028) than those without periventricular leukomalacia. Preoperative brain injury in neonates with transposition of the great arteries is associated with hypoxemia and longer time to surgery. We found no association between BAS and brain injury.