Abstract T MP63: Cardiac Diagnosis is the Major Risk for Stroke in Neonates with Complex Congenital Heart Defects
Background and Objectives: Complex congenital heart defects (CHD), which occur in approximately 3 out of 1000 neonates, require invasive open-heart surgery during the first year of life. In a recent prospective study of infants with various forms of complex CHD, 40% of neonates acquired post-operative brain injury including stroke and periventricular leukomalacia (PVL). However, studies identifying specific risk factors of post-operative stroke have been limited. Herein we examine risk factors for post-operative stroke in a mixed cohort of infants with critical CHD.
Methods: Term neonates born with critical CHD from 2009 to present were identified from a single-center prospective study. Exclusion criteria included birth weight less than 2 kg, neonatal depression, perinatal seizures, and evidence of end-organ injury. Magnetic resonance imaging (MRI) to assess pre- and post-operative brain injury was performed immediately prior to and within 10 days after surgery.
Results: Of 102 subjects enrolled, 85 neonates were imaged both pre- and post-operatively. Neonates were diagnosed with either hypoplastic left heart syndrome (HLHS, n=41), transposition of the great arteries (TGA, n=29) or other (n=15). A total of 9 arterial ischemic strokes were observed (10.6%), of which 7/9 were post-operative only. The incidence of stroke was significantly higher in infants with HLHS (6/41, 14.6%) than in infants with TGA (0/29, p=0.03). Time-to-surgery, head circumference, birth weight, duration of deep hypothermic circulatory arrest, and volume of pre- or post-operative PVL were not significantly correlated with incidence of stroke.
Conclusion: Neonates with HLHS have a higher prevalence of post-operative embolic stroke compared to infants with TGA. Although infants with HLHS have been shown to be at a high risk for both post-operative stroke and PVL, incidence of post-operative stroke is not correlated with volume of post-operative PVL.
Author Disclosures: M.E. Winters: None. A.L. McCarthy: None. J.M. Lynch: None. T. Ko: None. E. Bixler: None. K. Griffith: None. D.R. Busch: None. R. Xiao: None. W. Gaynor: None. S. Nicholson: None. L.M. Montenegro: None. M.Y. Naim: None. D.J. Licht: None.
- © 2015 by American Heart Association, Inc.