Author + information
- Hasti Sanandajifar,
- Emily S. Deaton,
- Majid Khan,
- Jorge Salazar and
- Mary Taylor
Head ultrasound (HUS) is the current preoperative standard of care for screening for brain abnormalities prior to congenital heart disease (CHD) surgical repair. Preoperative identification of intracranial hemorrhage and other abnormalities are particularly important given the risks of cardiopulmonary bypass. We hypothesized that rapid brain MRI may be a more effective means of screening than HUS in medically stable newborns. We have presented preliminary results that confirmed this finding; we now present our complete data.
All neonates under one month of age undergoing initial cardiac surgery were eligible to undergo both a specially-protocolized rapid sequence head MRI and a HUS. We retrospectively obtained data on feasibility and compared results of the two modalities. Differences in MRI and HUS reads were confirmed by a neuroradiologist.
Feasibility: From July 2013 to October 2017, 168 neonates were eligible for the study. Of these, 131 underwent both rapid brain MRI and HUS preoperatively. Twelve patients either had emergent surgery or were too unstable for MRI. Two did not tolerate MRI completion. There were no significant adverse events associated with obtaining MRI; no patients required sedation. Comparison Study: Of the 131 patients enrolled in the comparison study, HUS identified medically significant intracranial abnormalities in three (2%) and brain MRI in 33 (25%), representing a statistically significant difference (P < 0.0001). 30 patients (23%) had a normal HUS but abnormal rapid MRI. This represented 44 total events, further categorized by specific findings, including 26 instances of hemorrhage and 14 infarct. HUS detected nine abnormalities not demonstrated on MRI, but upon review with neuroradiologist these were deemed artifactual or insignificant.
Rapid brain MRI can be obtained quickly and safely in medically stable infants prior to CHD repair and is significantly more sensitive and specific for major intracranial pathology than HUS, providing a better neurological baseline prior to major cardiac surgery in neonates. Further studies are required to evaluate the long-term neurological outcome and prognosis in each case.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: Fetal Cardiology and the Patent Ductus Arteriosus
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1124-369
- 2018 American College of Cardiology Foundation