title: Cerebral lesions on magnetic resonance imaging correlate with preoperative neurological status in neonates undergoing cardiopulmonary bypass surgery.
abstract: OBJECTIVE
  To determine the prevalence, spectrum and course of cerebral lesions in neonates with congenital heart disease (CHD) undergoing full flow cardiopulmonary bypass (CPB) surgery using magnetic resonance imaging (MRI) and to examine the correlation between cerebral lesions and clinical neurological abnormalities.
  
  
  METHODS
  Prospective cohort study of neonates with d-transposition of the great arteries (n = 22), univentricular heart malformation with hypoplastic aortic arch (n = 6) and aortic arch obstructions (n = 2) undergoing CPB. Neonates underwent cerebral MRI and blinded standardized neurological examination before (median day 6) and after surgery (day 13). The MRI findings were compared with those of 20 healthy controls.
  
  
  RESULTS
  Preoperative cerebral lesions were present in 7 of 30 patients (23%) with isolated mild or moderate white matter injury (WMI) (n = 4), isolated small cerebral stroke (n = 1) and combined WMI and stroke (n = 2). None of the healthy controls had cerebral lesions on MRI. CHD neonates with preoperative cerebral lesions had more neurological abnormalities (P = 0.01) than neonates without cerebral lesions. Low arterial oxygen saturation (P = 0.03) was a risk factor for preoperative cerebral lesions, while balloon atrioseptostomy (P = 0.19) was not. After surgery, preoperative cerebral lesions persisted in 5 of 7 neonates, and 2 neonates (7%) showed signs of additional WMI in their postoperative MRI.
  
  
  CONCLUSIONS
  In neonates with severe CHD, WMI was the predominant preoperative finding, while cerebral strokes were less frequent. New postoperative lesions were rare. Preoperative neurological abnormalities correlated with the presence of cerebral lesions on MRI.
authors.affiliation: Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Sonia
authors.initials: S
authors.lastname: Bertholdt
authors.forename: Beatrice
authors.initials: B
authors.lastname: Latal
authors.forename: Rabia
authors.initials: R
authors.lastname: Liamlahi
authors.forename: René
authors.initials: R
authors.lastname: Prêtre
authors.forename: Ianina
authors.initials: I
authors.lastname: Scheer
authors.forename: Robert
authors.initials: R
authors.lastname: Goetti
authors.forename: Hitendu
authors.initials: H
authors.lastname: Dave
authors.forename: Vera
authors.initials: V
authors.lastname: Bernet
authors.forename: Achim
authors.initials: A
authors.lastname: Schmitz
authors.forename: Michael
authors.initials: M
authors.lastname: von Rhein
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
mesh_terms: D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D057234:Preoperative Period; D011446:Prospective Studies; D020521:Stroke / Q000473:pathology*; D016896:Treatment Outcome
keywords: Congenital heart disease; Developmental outcome; Neuroimaging; White matter injury