Header

UZH-Logo

Maintenance Infos

Smaller brain volumes at two years of age in patients with hypoplastic left heart syndrome - Impact of surgical approach


Knirsch, Walter; Heye, Kristina N; O'Gorman Tuura, Ruth; Hahn, Andreas; Wetterling, Kristina; Latal, Beatrice; Schranz, Dietmar; Reich, Bettina (2019). Smaller brain volumes at two years of age in patients with hypoplastic left heart syndrome - Impact of surgical approach. International Journal of Cardiology, (291):42-44.

Abstract

BACKGROUND
Brain growth in hypoplastic left heart syndrome (HLHS) is reduced before and after birth. Little is known about further brain growth until two years of age before Fontan procedure and the potential impact of type of surgery.
METHODS
In a prospective, two-center study 29 patients with HLHS and variants were treated by Norwood (n = 5) or Hybrid procedure (n = 24). At two years of age a cerebral MRI was performed and brain volumes (total gray, deep gray, white matter) and cerebrospinal fluid volume were calculated using FreeSurfer image analysis suite and compared to a healthy control group (n = 8).
RESULTS
The total brain volumes in patients with HLHS were smaller compared to controls (HLHS: 893 ± 76 ml vs. controls: 1015 ± 148 ml, p = 0.005). This difference was found in all three brain compartments after Norwood procedure, whereas patients after Hybrid procedure had total and deep gray volumes comparable to controls. When comparing Norwood to Hybrid patients, deep gray matter volume reduction was more pronounced (Norwood: 38.4 ± 4.1 ml vs. Hybrid: 44.4 ± 3.9 ml, p = 0.005) than white matter reduction (Norwood: 255 ± 19 ml vs. Hybrid: 285 ± 31 ml, p = 0.032).
CONCLUSIONS
Smaller total and regional brain volumes were found two years after Norwood or Hybrid procedure in children with HLHS. The brain volume reduction was more distinct after Norwood than after Hybrid procedure. Longitudinal studies are needed to identify impact of early staged-surgeries on brain development and may become part of the decision-making process in individual patients.

Abstract

BACKGROUND
Brain growth in hypoplastic left heart syndrome (HLHS) is reduced before and after birth. Little is known about further brain growth until two years of age before Fontan procedure and the potential impact of type of surgery.
METHODS
In a prospective, two-center study 29 patients with HLHS and variants were treated by Norwood (n = 5) or Hybrid procedure (n = 24). At two years of age a cerebral MRI was performed and brain volumes (total gray, deep gray, white matter) and cerebrospinal fluid volume were calculated using FreeSurfer image analysis suite and compared to a healthy control group (n = 8).
RESULTS
The total brain volumes in patients with HLHS were smaller compared to controls (HLHS: 893 ± 76 ml vs. controls: 1015 ± 148 ml, p = 0.005). This difference was found in all three brain compartments after Norwood procedure, whereas patients after Hybrid procedure had total and deep gray volumes comparable to controls. When comparing Norwood to Hybrid patients, deep gray matter volume reduction was more pronounced (Norwood: 38.4 ± 4.1 ml vs. Hybrid: 44.4 ± 3.9 ml, p = 0.005) than white matter reduction (Norwood: 255 ± 19 ml vs. Hybrid: 285 ± 31 ml, p = 0.032).
CONCLUSIONS
Smaller total and regional brain volumes were found two years after Norwood or Hybrid procedure in children with HLHS. The brain volume reduction was more distinct after Norwood than after Hybrid procedure. Longitudinal studies are needed to identify impact of early staged-surgeries on brain development and may become part of the decision-making process in individual patients.

Statistics

Citations

Altmetrics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:19 September 2019
Deposited On:10 Jan 2020 08:49
Last Modified:05 Feb 2020 08:38
Publisher:Elsevier
ISSN:0167-5273
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.ijcard.2019.03.055
PubMed ID:30952528

Download

Full text not available from this repository.
View at publisher

Get full-text in a library