title: Cerebral blood flow velocity and neurodevelopmental outcome in infants undergoing surgery for congenital heart disease.
abstract: BACKGROUND
  Cerebral blood flow velocity (CBFV) measured by transcranial Doppler sonography has provided information on cerebral perfusion in patients undergoing infant heart surgery, but no studies have reported a relationship to early postoperative and long-term neurodevelopmental outcomes.
  
  
  METHODS
  CBFV was measured in infants undergoing biventricular repair without aortic arch reconstruction as part of a trial of hemodilution during cardiopulmonary bypass (CPB); CBFV (Vm, mean; Vs, systolic; Vd, end-diastolic) in the middle cerebral artery and change in Vm (rVm) were measured intraoperatively and up to 18 hours post-CPB. Neurodevelopmental outcomes, measured at 1 year of age, included the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scales of Infant Development-II.
  
  
  RESULTS
  CBFV was measured in 100 infants; 43 with D-transposition of the great arteries, 36 with tetralogy of Fallot, and 21 with ventricular septal defects. Lower Vm, Vs, Vd, and rVm at 18 hours post-CPB were independently related to longer intensive care unit duration of stay (p<0.05). In the 85 patients who returned for neurodevelopmental testing, lower Vm, Vs, Vd, and rVm at 18 hours post-CPB were independently associated with lower PDI (p<0.05) and MDI (p<0.05, except Vs: p=0.06) scores. Higher Vs and rVm at 18 hours post-CPB were independently associated with increased incidence of brain injury on magnetic resonance imaging in 39 patients.
  
  
  CONCLUSIONS
  Postoperative CBFV after biventricular repair is related to early postoperative and neurodevelopmental outcomes at 1 year of age, possibly indicating that low CBFV is a marker of suboptimal postoperative hemodynamics and cerebral perfusion.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: henry.cheng@cardio.chboston.org.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.affiliation: Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Bellinger
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Stopp
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Janet S
authors.initials: JS
authors.lastname: Soul
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Kussman
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002560:Cerebrovascular Circulation; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006438:Hemodilution / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D011596:Psychomotor Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial