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J Thorac Cardiovasc Surg. 2016 Oct;152(4):1095-103. doi: 10.1016/j.jtcvs.2016.05.027. Epub 2016 May 28.

Cerebral oxygen delivery is reduced in newborns with congenital heart disease.

Author information

1
Department of Physiology, University of Toronto, Toronto, Ontaria, Canada.
2
McGill University, Montreal, Quebec, Canada.
3
Institute of Medical Science, University of Toronto, Toronto, Ontaria, Canada.
4
Department of Neurology, The Hospital for Sick Children, Toronto, Ontaria, Canada.
5
Department of Medical Imaging, University of Toronto, Toronto, Ontaria, Canada.
6
Department of Medical Imaging, University of Toronto, Toronto, Ontaria, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontaria, Canada.
7
Department of Neurology, The Hospital for Sick Children, Toronto, Ontaria, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontaria, Canada.
8
Department of Pediatrics, University of Toronto, Toronto, Ontaria, Canada; Department of Diagnostic Imaging, University of Toronto, Toronto, Ontaria, Canada. Electronic address: mike.seed@sickkids.ca.

Abstract

OBJECTIVE:

To investigate preoperative cerebral hemodynamics in newborns with congenital heart disease. We hypothesized that cerebral blood flow and oxygen delivery would be decreased in newborns with congenital heart disease compared with controls.

METHODS:

Using a "feed-and-sleep" approach to performing neonatal magnetic resonance imaging, we measured cerebral blood flow by using a slice prescription perpendicular to the right and left internal carotid arteries and basilar artery at the level of the clivus. We calculated brain volume by segmenting a 3-dimensional steady-state free procession acquisition of the whole brain, allowing quantification of cerebral blood flow indexed to brain volume. Cerebral oxygen delivery was calculated as the product of cerebral blood flow and preductal systemic arterial oxygen content obtained via a combination of conventional pulse oximetry and laboratory analysis of venous blood samples for hemoglobin concentration.

RESULTS:

A complete set of measurements were obtained in 32 newborns with heart disease and 31 controls. There was no difference in gestational age between the heart disease and control groups. There was no difference in cerebral blood flow compared with controls (103.5 ± 34.0 vs 119.7 ± 40.4 mL/min), whereas cerebral oxygen delivery was significantly lower in the congenital heart disease subjects (1881 ± 625.7 vs 2712 ± 915.7 mLO2/min). Ten newborns with congenital heart disease had diffuse excessive high signal intensity in their white matter and 2 had white matter injury whereas another 5 had both.

CONCLUSIONS:

Newborns with unrepaired cyanotic congenital heart disease have decreased cerebral oxygen delivery due to arterial desaturation. If brain growth and development are adversely affected through oxygen conformance, our findings could have clinical implications in terms of timing of surgical repair.

KEYWORDS:

cerebral blood flow; cerebral oxygen delivery; congenital heart disease; preoperative management

PMID:
27349283
DOI:
10.1016/j.jtcvs.2016.05.027
[Indexed for MEDLINE]
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