Objectives: 

The aims of this study were to: i) determine the spectrum of brain injury and ii) compare brain volumes between pre- and postoperative brain MRI in the infants receiving extracorporeal membrane oxygenation compared with those who did not require extracorporeal membrane oxygenation.

Design: 

Cohort study of infants with d-transposition of the great arteries or single ventricle physiology. Brain volume (cm³) was measured using a segmentation of a volumetric T1-weighted gradient echo sequence. Brain imaging findings (intraventricular hemorrhage, white matter injuries, and stroke) were analyzed with respect to known clinical risk factors for brain injury and adverse neurodevelopmental outcomes. Clinical factors were collected by retrospective chart review. The association between brain volume and extracorporeal membrane oxygenation was evaluated using generalized estimating equations to account for repeated measures.

Setting: 

Prospective and single-centered study.

Patients: 

One hundred nine infants (median gestational age, 39.1 wk) with d-transposition of the great arteries (n = 77) or single ventricle physiology (n = 32) were studied pre- and postoperatively with MRI as per clinical protocol.

Interventions: 

None.

Measurements and Main Results: 

Of the 28 infants (26%) receiving extracorporeal membrane oxygenation, 19 (68%) were supported with extracorporeal membrane oxygenation once, and nine (32%) were supported 2–4 times. On postoperative MRI, new white matter injury was found in only five (17%) of the extracorporeal membrane oxygenation infants versus 40 (49%) in the non–extracorporeal membrane oxygenation group (p = 0.073). The rate of stroke (9% vs 10%), intraventricular hemorrhage (24% vs 29%), and hypoxic ischemia (3% vs 14%) did not differ between the non–extracorporeal membrane oxygenation and extracorporeal membrane oxygenation groups (all p > 0.5). Accounting for d-transposition of the great arteries or single ventricle physiology diagnosis, infants requiring extracorporeal membrane oxygenation had slower brain volume with single (β = –1.67) or multiple extracorporeal membrane oxygenation runs ([β = –6.54]; overall interaction p = 0.012).

Conclusions: 

Patients with d-transposition of the great arteries or single ventricle physiology undergoing extracorporeal membrane oxygenation at our center have a similar incidence of brain injury but more significant impairment of perioperative brain volumes than those not requiring extracorporeal membrane oxygenation.

中文翻译：

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进行静脉动脉体外膜氧合的先天性心脏病的脑容量和婴儿数量减少。

目标： 

这项研究的目的是：i）确定接受体外膜氧合的婴儿与不需要进行体外膜氧合的婴儿相比，术前和术后脑MRI的脑容量，以及ii）进行比较。

设计： 

d换位大动脉或单心室生理的婴儿的队列研究。使用体积T1加权梯度回波序列的分段测量脑体积（cm ³）。针对已知的脑损伤和不良神经发育结果的临床危险因素，分析了脑成像发现（脑室内出血，白质损伤和中风）。通过回顾性图表审查收集临床因素。使用广义估计方程评估大脑体积与体外膜氧合之间的关联，以考虑重复测量。

设置： 

前瞻性和单中心研究。

耐心： 

MRI术前和术后根据临床方案研究了109例婴儿（中位胎龄39.1 wk），其大动脉d移位（n = 77）或单心室生理（n = 32）。

干预措施： 

没有。

测量和主要结果： 

28名婴儿（26％）的接收体外膜肺氧合，19（68％）与得到支持体外膜肺氧合一次，和9（32％）得到了支持2-4倍。对术后MRI，新白质损伤仅在五（17％）的发现体外膜肺氧合的非婴儿比40（49％）体外膜肺氧合组（p = 0.073）。中风（9％和10％），脑室内出血（24％比29％），和缺氧缺血（3％和14％）的速率非之间没有差异体外膜肺氧合和体外膜肺氧合组（所有p> 0.5）。考虑到大动脉的d换位或单心室生理学诊断，需要进行体外膜氧合的婴儿单次（β= –1.67）或多次进行体外膜氧合（[β= –6.54]；整体相互作用p = 0.012）。

结论： 

在我们中心经历大动脉d转位或单心室生理学改变的患者进行体外膜氧合的患者发生脑损伤的可能性相似，但与不需要体外膜氧合的患者相比，围手术期脑容量的损害更为严重。