Time course of cranial ultrasound abnormalities after arterial switch operation in neonates.
BACKGROUND
The object of this study was to investigate the time course and fate of abnormal findings in cranial ultrasound after performing an arterial switch operation in neonates with transposition of the great arteries, and to analyze the relationship to cerebral cell damage.


METHODS
Cranial ultrasound was performed prospectively in 35 neonates with transposition of the great arteries before the operation as well as 4 hours, 1, 2, and 3 days, and 1 and 2 weeks postoperatively. Blood levels of neuron-specific enolase, a marker of cerebral cell damage, were determined before, during, and 4 and 24 hours postoperatively.


RESULTS
In 17 of 35 neonates (49%), early postoperative cranial ultrasound revealed abnormalities indistinguishable from intraventricular hemorrhage. In 11 neonates findings were transient and were normalized 2 weeks postoperatively, whereas in the remaining 6 neonates there was evidence of resolving hemorrhage. In all neonates there was a rise in neuron-specific enolase blood concentrations during and 4 hours after extracorporal circulation without correlation to sonographic findings.


CONCLUSIONS
Enhanced echogenicity of the choroid plexus or dilatation of the cerebral ventricular system is a frequent early postoperative finding that may be caused by transient plexus edema rather than intraventricular hemorrhage and is not related to cerebral cell damage.
Sigler
M
M
Department of Pediatric Cardiology, Aachen University of Technology, Germany. matthias.sigler@post.rwth-aachen.de
Vazquez-Jimenez
J F
JF
Grabitz
R G
RG
Hövels-Gürich
H H
HH
Messmer
B J
BJ
von Bernuth
G
G
Seghaye
M C
MC
D001158:Arteries / Q000601:surgery; D004453:Echoencephalography; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D011182:Postoperative Care; D011446:Prospective Studies; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D014656:Vascular Surgical Procedures