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Ann Thorac Surg 2004;77:1698-1706
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Preoperative brain injury in newborns with transposition of the great arteries

Steven P. Miller, MDa,b*, Patrick S. McQuillen, MDb, Daniel B. Vigneron, PhDc, David V. Glidden, PhDd, A. James Barkovich, MDa,b,c, Donna M. Ferriero, MDa,b, Shannon E. G. Hamrick, MDb, Anthony Azakie, MDe, Tom R. Karl, MDe

a Department of Neurology, San Francisco, CA, USA
b Department of Pediatrics, San Francisco, CA, USA
c Department of Radiology, San Francisco, CA, USA
d Department of Epidemiology, San Francisco, CA, USA
e Department of Cardiothoracic Surgery, University of California, San Francisco, California, USA

Accepted for publication October 28, 2003.

* Address reprint requests to Dr Miller, 521 Parnassus Ave, Room C-215, San Francisco, CA 94143-0663, USA
e-mail: smille{at}itsa.ucsf.edu

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: The objective was to determine the timing and mechanism of brain injury using preoperative and postoperative magnetic resonance imaging (MRI) and three-dimensional MR spectroscopic imaging (MRSI) in newborns with transposition of the great arteries (TGA) repaired with full-flow cardiopulmonary bypass.

METHODS: Ten term newborns with TGA undergoing an arterial switch operation were studied with MRI, MRSI, and neurologic examination preoperatively and postoperatively at a median of 5 days (2 to 9 days) and 19 days (14 to 26 days) of age, respectively. Five term historical controls were studied at a median of 4 days (3 to 9 days). Lactate/choline (marker of cerebral oxidative metabolism) and N-acetylaspartate (NAA)/choline (marker of cerebral metabolism and density) were measured bilaterally from the basal ganglia, thalamus, and corticospinal tracts.

RESULTS: Four TGA newborns had brain injury on the preoperative MRI. The only new lesion detected on the postoperative study was a focal white matter lesion in one newborn with a normal preoperative MRI. The MRSI of age-adjusted lactate/choline was quantitatively higher in newborns with TGA compared with those without heart disease (p < 0.0001), even in newborns without MRI evidence of preoperative brain injury. Lactate/choline decreased after surgery but remained elevated compared with controls. In newborns with TGA, those with preoperative brain injury on MRI had lower NAA/choline globally (p = 0.04) than those with normal preoperative MRI. Five newborns had a decline in NAA/choline from the preoperative to postoperative studies.

CONCLUSIONS: Abnormal brain metabolism and injury was observed preoperatively in newborns with TGA. Brain injury is not solely related to the operative course.




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