Periventricular leukomalacia is common after neonatal cardiac surgery

Kristen K. Galli, Robert A. Zimmerman, Gail P. Jarvik, Gil Wernovsky, Marijn K. Kuypers, Robert R. Clancy, Lisa M. Montenegro, William T. Mahle, Mark F. Newman, Ann M. Saunders, Susan C. Nicolson, Thomas L. Spray, J. William Gaynor, Ross M. Ungerleider, James S. Tweddell, Glen Van Arsdell, Frank L. Hanley

Research output: Contribution to journalArticlepeer-review

286 Scopus citations

Abstract

Objectives: Periventricular leukomalacia is necrosis of the cerebral white matter adjacent to the lateral ventricles and results from injury to immature oligodendroglia. In infants without congenital heart disease, periventricular leukomalacia is associated with an increased incidence of developmental delay and attention deficit/hyperactivity disorder. The incidence of periventricular leukomalacia and the risk factors for development of periventricular leukomalacia after infant cardiac surgery are not known. Methods: Magnetic resonance imaging of the brain was performed 6 to 14 days after cardiac surgery utilizing cardiopulmonary bypass with or without deep hypothermic circulatory arrest in 105 neonates and infants ≤ 6 months of age. Results: Median age at surgery was 6 days (range 1-178), with 82 neonates (age ≤ 30 days). Periventricular leukomalacia was found in 44 of the neonates (54%) compared with 1 of 23 infants (4%). Forward logistic regression using age at surgery as a continuous variable identified a model containing longer total support time (cardiopulmonary bypass plus deep hypothermic circulatory arrest), lower systolic blood pressure at cardiac intensive care unit admission postoperatively, lower minimum diastolic blood pressure, and PO2 in the first 48 hours after surgery. When age at surgery was considered as a dichotomous variable (neonate versus infant), younger age at surgery replaced systolic blood pressure, PO2, and total support time in the model. Lower minimum diastolic blood pressure was a significant risk factor in both models. Conclusions: Periventricular leukomalacia was found in >50% of neonates after cardiac surgery but rarely in older infants. Hypoxemia and hypotension in the early postoperative period, particularly diastolic hypotension, may be important risk factors for periventricular leukomalacia.

Original languageEnglish
Pages (from-to)692-704
Number of pages13
JournalJournal of Thoracic and Cardiovascular Surgery
Volume127
Issue number3
DOIs
StatePublished - Mar 2004

Bibliographical note

Funding Information:
Supported by grants from the Fourjay Foundation and The American Heart Association (9950480).

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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