Clinical Research
Congenital Heart Disease
Pre-Operative Brain Injury in Newborn Infants With Transposition of the Great Arteries Occurs at Rates Similar to Other Complex Congenital Heart Disease and Is Not Related to Balloon Atrial Septostomy

https://doi.org/10.1016/j.jacc.2009.01.061Get rights and content
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Objectives

The goal of this study was to determine the prevalence and pattern of pre-operative brain injury in infants with transposition of the great arteries (TGA) compared with other complex congenital heart disease (CHD) and to define the risk of balloon atrial septostomy (BAS) for the development of brain injury.

Background

It has recently been suggested that infants with TGA are at increased risk of pre-operative brain injury, in particular, stroke, and that this is strongly associated with having a BAS.

Methods

Sixty-four newborn infants with TGA (n = 44), hypoplastic left heart syndrome (n = 13), or pulmonary atresia (n = 7) had magnetic resonance imaging (MRI) scans performed before surgery.

Results

Thirty-three (75%) of the infants with TGA had a BAS. Brain injury occurred in 19 (30%) infants: white matter injury (WMI) in 17 (27%), and stroke in 3 (5%). There was no difference in the prevalence or pattern of brain injury between diagnostic groups. There was no association between BAS and brain injury in infants with TGA. There was a trend toward increased brain injury in TGA with an intact interventricular septum compared with TGA with a ventricular septal defect (38% vs. 8%, p = 0.075). There was no association between brain injury and any clinical variables.

Conclusions

Pre-operative brain injury on MRI scan was present in 30% of infants with CHD. The predominant pattern was WMI. The rates and patterns of pre-operative brain injury are similar in infants with TGA compared with other complex CHD, and BAS does not increase the risk of pre-operative brain injury.

Key Words

transposition of the great vessels
heart defects congenital
brain injuries
magnetic resonance imaging
balloon septostomy

Abbreviations and Acronyms

ASO
arterial switch operation
BAS
balloon atrial septostomy
CHD
congenital heart disease
CI
confidence interval
HLHS
hypoplastic left heart syndrome
MRI
magnetic resonance imaging
PA
pulmonary atresia
TGA
transposition of the great arteries
VSD
ventricular septal defect
WMI
white matter injury

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Supported by grants from The National Heart Foundation of New Zealand, The National Heart Foundation of Australia, Auckland Medical Research Foundation, The Murdoch Children's Research Institute, and the Green Lane Research and Education Fund.