title: Brain magnetic resonance immediately before surgery in single ventricles and surgical postponement.
abstract: BACKGROUND
  Single-ventricle patients undergoing surgical reconstruction experience a high rate of brain injury. Incidental findings on preoperative brain scans may result in safety considerations involving hemorrhage extension during cardiopulmonary bypass that result in surgical postponement.
  
  
  METHODS
  Single-ventricle patients were studied with brain scans immediately preoperatively, as part of a National Institutes of Health study, and were reviewed by neuroradiology immediately before cardiopulmonary bypass.
  
  
  RESULTS
  Of 144 consecutive patients recruited into the project, 33 were studied before stage I (3.7±1.8 days), 34 before bidirectional Glenn (5.8±0.5 months), and 67 before Fontan (3.3±1.1 years) operations. Six operations (4.5%), 2 before stage I, 3 before bidirectional Glenn, and 1 before Fontan, were postponed because of concerning findings on brain magnetic resonance imaging. Five were due to unexpected incidental findings of acute intracranial hemorrhage, and 1 was due to diffuse cerebellar cytotoxic edema; none who proceeded to operation had these lesions. Prematurity and genetic syndromes were not present in any patients with a postponed operation. Four of 4 before bidirectional Glenn/Fontan with surgical delays had hypoplastic left heart syndrome compared with 44 of 97 who did not (p=0.048). After observation and follow-up, all eventually had successful operations with bypass.
  
  
  CONCLUSIONS
  Preoperative brain magnetic resonance imaging performed in children with single ventricles disclosed injuries in 4.5% leading to surgical delay; hemorrhagic lesions were most common and raised concerns for extension during the operation. The true risk of progression and need for delay of the operation due to heparinization associated with these lesions remains uncertain.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Electronic address: fogel@email.chop.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fogel
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Tom
authors.initials: T
authors.lastname: Pawlowski
authors.affiliation: Department of Neurology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwab
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Laura Diaz
authors.initials: LD
authors.lastname: Berenstein
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fuller
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Whitehead
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.affiliation: Department of Neurology, The Children's Hospital of Philadelphia/The Perelman School of Medicine at The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
mesh_terms: D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D057234:Preoperative Period; D015203:Reproducibility of Results; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome