Dent Catherine L, Spaeth James P, Jones Blaise V, Schwartz Steven M, Glauser Tracy A, Hallinan Barbara, Pearl Jeffrey M, Khoury Philip R, Kurth C Dean
Department of Pediatrics, Division of Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
J Thorac Cardiovasc Surg. 2005 Dec;130(6):1523-30. doi: 10.1016/j.jtcvs.2005.07.051.
Neurologic deficits are common after the Norwood procedure for hypoplastic left heart syndrome. Because of the association of deep hypothermic circulatory arrest with adverse neurologic outcome, regional low-flow cerebral perfusion has been used to limit the period of intraoperative brain ischemia. To evaluate the effect of this technique on brain ischemia, we performed serial brain magnetic resonance imaging in a cohort of infants before and after the Norwood operation using regional cerebral perfusion.
Twenty-two term neonates with hypoplastic left heart syndrome were studied with brain magnetic resonance imaging before and at a median of 9.5 days after the Norwood operation. Results were compared with preoperative, intraoperative, and postoperative risk factors to identify predictors of neurologic injury.
Preoperative magnetic resonance imaging (n = 22) demonstrated ischemic lesions in 23% of patients. Postoperative magnetic resonance imaging (n = 15) demonstrated new or worsened ischemic lesions in 73% of patients, with periventricular leukomalacia and focal ischemic lesions occurring most commonly. Prolonged low postoperative cerebral oximetry (<45% for >180 minutes) was associated with the development of new or worsened ischemia on postoperative magnetic resonance imaging (P = .029).
Ischemic lesions occur commonly in neonates with hypoplastic left heart syndrome before surgical intervention. Despite the adoption of regional cerebral perfusion, postoperative cerebral ischemic lesions are frequent, occurring in the majority of infants after the Norwood operation. Long-term follow-up is necessary to assess the functional effect of these lesions.
在用于治疗左心发育不全综合征的诺伍德手术之后，神经功能缺损很常见。由于深低温循环停搏与不良神经学转归相关，区域低流量脑灌注已被用于限制术中脑缺血的时长。为了评估该技术对脑缺血的影响，我们对一组接受诺伍德手术并采用区域脑灌注的婴儿在术前和术后进行了系列脑磁共振成像检查。
对22名足月新生儿左心发育不全综合征患者在诺伍德手术前及术后中位时间9.5天进行脑磁共振成像检查。将结果与术前、术中和术后的危险因素进行比较，以确定神经损伤的预测因素。
术前磁共振成像（n = 22）显示23%的患者存在缺血性病变；术后磁共振成像（n = 15）显示73%的患者有新的或加重的缺血性病变，最常见的是脑室周围白质软化和局灶性缺血性病变。术后脑氧饱和度持续偏低（<45%超过180分钟）与术后磁共振成像上新的或加重的缺血性病变的发生相关（P = 0.029）。
在手术干预前，缺血性病变在左心发育不全综合征的新生儿中很常见。尽管采用了区域脑灌注，但术后脑缺血性病变仍很频繁，在诺伍德手术后的大多数婴儿中都会出现。需要进行长期随访以评估这些病变的功能影响。
