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CEREBRAL BLOOD FLOW VELOCITY AND DEVELOPMENTAL OUTCOME IN INFANTS UNDERGOING SURGICAL REPAIR OF CONGENITAL HEART DISEASE
E755 JACC March 27, 2012 Volume 59, Issue 13
Congenital Cardiology Solutions CEREBRAL BLOOD FLOW VELOCITY AND DEVELOPMENTAL OUTCOME IN INFANTS UNDERGOING SURGICAL REPAIR OF CONGENITAL HEART DISEASE ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions : Surgical Considerations Abstract Category: 27. Congenital Cardiology Solutions: Pediatric Presentation Number: 1135-124 Authors: Henry Cheng, David Wypij, Peter Laussen, David Bellinger, Christian D. Stopp, Jane Newburger, Barry Kussman, Children’s Hospital Boston, Boston, MA, USA Background: Cerebral blood flow velocity (CBFV) measured by transcranial Doppler sonography has provided insight into cerebral perfusion in patients undergoing surgical repair of congenital heart disease. However, a relationship between CBFV and developmental outcome has not been established. Methods: Infants <9 months of age undergoing 2-ventricle repair without aortic arch obstruction were enrolled in a prospective trial evaluating the effects of hematocrit during cardiac surgery. CBFV (Vs, systolic; Vd, diastolic; Vm, mean) of the M1 segment of the middle cerebral artery was measured at set time-points intraoperatively and up to 18 hours post cardiopulmonary bypass. Baseline measurements were performed following induction of anesthesia. Subsequent Vm measurements were compared to the baseline value to evaluate the relative change in Vm (rVm). Perioperative data were recorded daily, and the Psychomotor (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development-II were measured at age 1 year. Results: The study cohort included 100 subjects: 43 with dextro-transposition of the great arteries (D-TGA), 36 with tetralogy of Fallot (TOF), and 21 with ventricular septal defects (VSD). CBFV at baseline varied with diagnosis, with younger D-TGA subjects (median age at surgery 5 days) having lower CBFV values than older TOF (66 days) and VSD (107 days) subjects (p<0.01 for Vs, Vd, Vm). CBFVs intraoperatively and at 1 and 6 hours post cardiopulmonary bypass did not correlate with PDI or MDI. Higher rVm at 18 hours post cardiopulmonary bypass was correlated (Spearman) with higher PDI (r=0.24, p<0.04) and MDI (r=0.28, p<0.02). In multivariable analysis, the relationship between higher rVm at 18 hours post cardiopulmonary bypass and higher PDI (p<0.03) and MDI (p=0.004) persisted after controlling for social class, diagnosis group, and age at surgery. Conclusion: Early changes in mean CBFV after repair of congenital heart disease are related to developmental outcome at age 1 year. This finding may be explained by an increase in cerebral blood flow and oxygen delivery with the achievement of normal circulatory physiology.
Congenital Cardiology Solutions CEREBRAL BLOOD FLOW VELOCITY AND DEVELOPMENTAL OUTCOME IN INFANTS UNDERGOING SURGICAL REPAIR OF CONGENITAL HEART DISEASE ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions : Surgical Considerations Abstract Category: 27. Congenital Cardiology Solutions: Pediatric Presentation Number: 1135-124 Authors: Henry Cheng, David Wypij, Peter Laussen, David Bellinger, Christian D. Stopp, Jane Newburger, Barry Kussman, Children’s Hospital Boston, Boston, MA, USA Background: Cerebral blood flow velocity (CBFV) measured by transcranial Doppler sonography has provided insight into cerebral perfusion in patients undergoing surgical repair of congenital heart disease. However, a relationship between CBFV and developmental outcome has not been established. Methods: Infants <9 months of age undergoing 2-ventricle repair without aortic arch obstruction were enrolled in a prospective trial evaluating the effects of hematocrit during cardiac surgery. CBFV (Vs, systolic; Vd, diastolic; Vm, mean) of the M1 segment of the middle cerebral artery was measured at set time-points intraoperatively and up to 18 hours post cardiopulmonary bypass. Baseline measurements were performed following induction of anesthesia. Subsequent Vm measurements were compared to the baseline value to evaluate the relative change in Vm (rVm). Perioperative data were recorded daily, and the Psychomotor (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Development-II were measured at age 1 year. Results: The study cohort included 100 subjects: 43 with dextro-transposition of the great arteries (D-TGA), 36 with tetralogy of Fallot (TOF), and 21 with ventricular septal defects (VSD). CBFV at baseline varied with diagnosis, with younger D-TGA subjects (median age at surgery 5 days) having lower CBFV values than older TOF (66 days) and VSD (107 days) subjects (p<0.01 for Vs, Vd, Vm). CBFVs intraoperatively and at 1 and 6 hours post cardiopulmonary bypass did not correlate with PDI or MDI. Higher rVm at 18 hours post cardiopulmonary bypass was correlated (Spearman) with higher PDI (r=0.24, p<0.04) and MDI (r=0.28, p<0.02). In multivariable analysis, the relationship between higher rVm at 18 hours post cardiopulmonary bypass and higher PDI (p<0.03) and MDI (p=0.004) persisted after controlling for social class, diagnosis group, and age at surgery. Conclusion: Early changes in mean CBFV after repair of congenital heart disease are related to developmental outcome at age 1 year. This finding may be explained by an increase in cerebral blood flow and oxygen delivery with the achievement of normal circulatory physiology.