Cucerea Manuela, Ognean Maria-Livia, Pinzariu Alin-Constantin, Simon Marta, Suciu Laura Mihaela, Ghiga Dana-Valentina, Moldovan Elena, Moscalu Mihaela
Neonatology Department, GEP University of Medicine Pharmacy, Science and Technology of Targu Mures, 540142 Târgu Mureș, Romania.
Dental Medicine and Nursing Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania.
Biomedicines. 2024 Sep 4;12(9):2018. doi: 10.3390/biomedicines12092018.
Dextro-transposition of the great arteries (D-TGA) is a critical congenital heart defect that can impact neurodevelopment due to cerebral perfusion and oxygenation disorders followed by alterations in synaptogenesis, gyrification, sulcation, and the microstructure. Brain injuries can occur both pre-operatively and postoperatively, especially white matter injuries, neuronal loss, and stroke. : In a retrospective study conducted at a tertiary center between 2016 and 2023, we investigated the early effects of Prostaglandin E1 (PGE1) administration and balloon atrial septostomy (BAS) on cerebral blood flow and oxygenation in inborn neonates with D-TGA. Cerebral Doppler Ultrasound in the anterior cerebral artery (ACA) was performed to assess the resistive index (RI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EVD) before PGE1, before the BAS procedure, and 24 h after birth. Cerebral regional saturations of oxygen (crSO) and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated. D-TGA patients were divided into the PGE1 group and the PGE1 + BAS group. Age-matched healthy controls were used for comparison. : All 83 D-TGA newborns received PGE1 within two hours after delivery, of whom 46 (55.42%) underwent BAS. In addition, 77 newborns composed the control group. PGE1 administration increased crSO from 47% to 50% in the PGE1 group, but lower than in controls at 24 h of life, while cFTOE remained elevated. The RI increased 24 h after delivery (0.718 vs. 0.769; = 0.000002) due to decreased EDV (10.71 vs. 8.74; < 0.0001) following PGE1 treatment. The BAS procedure resulted in a significant increase in crSO from 42% to 51% at 24 h of life in the PGE1 + BAS group. Doppler parameters exhibited a similar trend as observed in the PGE1 group. : PGE1 treatment and BAS are lifesaving interventions that may improve cerebral perfusion and oxygenation in newborns with D-TGA during the transition period, as reflected by increasing SpO and crSO.
大动脉右位转位（D-TGA）是一种严重的先天性心脏缺陷，由于脑灌注和氧合障碍，随后在突触发生、脑回形成、脑沟形成和微观结构方面发生改变，可影响神经发育。脑损伤可发生在术前和术后，尤其是白质损伤、神经元丢失和中风。：在2016年至2023年于一家三级中心进行的一项回顾性研究中，我们调查了前列腺素E1（PGE1）给药和球囊房间隔造口术（BAS）对患有D-TGA的先天性新生儿脑血流和氧合的早期影响。在PGE1给药前、BAS手术前和出生后24小时，在前脑动脉（ACA）进行脑多普勒超声检查，以评估阻力指数（RI）、收缩期峰值速度（PSV）和舒张末期速度（EVD）。评估脑局部氧饱和度（crSO）和脑组织氧分数提取（cFTOE）。D-TGA患者分为PGE1组和PGE1 + BAS组。使用年龄匹配的健康对照进行比较。：所有83例D-TGA新生儿在出生后两小时内接受了PGE1治疗，其中46例（55.42%）接受了BAS。此外，77例新生儿组成了对照组。PGE1给药使PGE1组的crSO从47%提高到50%，但在出生后24小时低于对照组，而cFTOE仍然升高。由于PGE1治疗后EDV降低（10.71对8.74；<0.0001），出生后24小时RI升高（0.718对0.769；=0.000002）。BAS手术使PGE1 + BAS组在出生后24小时的crSO从42%显著提高到51%。多普勒参数呈现出与PGE1组相似的趋势。：PGE1治疗和BAS是挽救生命的干预措施，可在过渡期改善患有D-TGA的新生儿的脑灌注和氧合，这表现为SpO和crSO升高。
