Journal article

Publication year: 2019

Pages: 1838-1844

Journal: The Annals of Thoracic Surgery

Volume number: 107

Issue number: 6

ISSN: 0003-4975

eISSN: 1552-6259

Open access status: Green

DOI Link: https://doi.org/10.1016/j.athoracsur.2018.12.012

Publisher: Elsevier

Abstract: 

Background. The long-term impact of altered hemodynamics after stage II in children with hypoplastic left heart syndrome (HLHS) and hypoplastic left heart complex (HLHC) on cerebral growth and neurodevelopmental outcome is unknown. We aimed to investigate whether elevated central venous and atrial filling pressures before the Fontan procedure may be associated with smaller brain volumes and poorer neurodevelopmental outcome after the initial hybrid procedure.

Methods. In a two-center cohort study semiautomated segmentation of cerebral magnetic resonance imaging scans was conducted in 25 children with HLHS/HLHC (25 hybrid) before the Fontan procedure (27.6 +/- 4.3 months) and in 8 healthy control subjects (29.7 +/- 9.5 months). Study patients were evaluated with the Bayley Scales of Infant and Toddler Development III (Bayley-III) and a neurologic examination. Hemodynamic measures after stage II were assessed with cardiac catheterization at 2 years of age before Fontan completion. Children with known genetic comorbidities were excluded.

Results. In HLHS/HLHC patients higher atrial filling pressures (6 +/- 3 mm Hg; range, 2-14) were correlated with reduced brain volumes and lower language composite score, whereas higher Glenn pressures (10 +/- 3 mm Hg; range, 6-16) were related to higher cerebrospinal fluid, reduced brain volumes, and lower cognitive, language, and motoric composite scores in the Bayley-III. Compared with control subjects white matter volumes were reduced and cerebrospinal fluid volumes increased in study patients.

Conclusions. These data suggest that altered cardiovascular hemodynamics after stage II influence brain growth and neurodevelopmental outcome in infants with HLHS/HLHC. (C) 2019 by The Society of Thoracic Surgeons

Harvard Citation style: Reich, B., Heye, K., Tuura, R., Beck, I., Wetterling, K., Hahn, A., et al. (2019) Interrelationship Between Hemodynamics, Brain Volumes, and Outcome in Hypoplastic Left Heart Syndrome, The Annals of Thoracic Surgery, 107(6), pp. 1838-1844. https://doi.org/10.1016/j.athoracsur.2018.12.012

APA Citation style: Reich, B., Heye, K., Tuura, R., Beck, I., Wetterling, K., Hahn, A., Aktintuerk, H., Schranz, D., Jux, C., Kretschmar, O., Huebler, M., Latal, B., & Knirsch, W. (2019). Interrelationship Between Hemodynamics, Brain Volumes, and Outcome in Hypoplastic Left Heart Syndrome. The Annals of Thoracic Surgery. 107(6), 1838-1844. https://doi.org/10.1016/j.athoracsur.2018.12.012