Clinical and neuroimaging characteristics of cerebral sinovenous thrombosis in neonates undergoing cardiac surgery
Claessens, Nathalie H.P.; Algra, Selma O.; Jansen, Nicolaas J.G.; Groenendaal, Floris; de Wit, Esther; Wilbrink, Alexander A; Haas, Felix; Schouten, Antonius N J Schouten; Nievelstein, Rutger A.J.; Benders, Manon J.N.L.; de Vries, Linda S.
(2018) Journal of Thoracic and Cardiovascular Surgery, volume 155, issue 3, pp. 1150 - 1158
(Article)
Abstract
Objectives: Neonates with congenital heart disease may have an increased risk of cerebral sinovenous thrombosis, but incidence rates are lacking. This study describes the clinical and neuroimaging characteristics of cerebral sinovenous thrombosis in neonates undergoing cardiac surgery. Methods: Forty neonates (78% male) requiring neonatal univentricular or biventricular cardiac repair using
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cardiopulmonary bypass were included. All underwent preoperative (median postnatal day 7) and postoperative (median postoperative day 7) magnetic resonance imaging of the brain, including venography, to detect cerebral sinovenous thrombosis. Clinical characteristics were compared between cerebral sinovenous thrombosis positive and cerebral sinovenous thrombosis negative neonates. Results: Postoperatively, cerebral sinovenous thrombosis was diagnosed in 11 neonates (28%), with the transverse sinus affected in all, and involvement of multiple sinuses in 10 (91%). Preoperatively, signs of thrombosis were seen in 3 cases (8%). Focal infarction of the basal ganglia was significantly more common in cerebral sinovenous thrombosis positive than cerebral sinovenous thrombosis negative neonates (P = .025). Cerebral sinovenous thrombosis positive neonates spent more time in the intensive care unit preoperatively (P = .001), had lower weight (P = .024) and lower postmenstrual age (P = .030) at surgery, and had prolonged use of a central venous catheter (P = .023) and a catheter placed in the internal jugular vein more often (P = .039). Surgical and postoperative factors were not different between new postoperative cerebral sinovenous thrombosis positive and cerebral sinovenous thrombosis negative neonates. Conclusions: Cerebral sinovenous thrombosis might be more common than previously understood in neonates undergoing cardiac surgery. In our study, cerebral sinovenous thrombosis was associated with a higher risk of additional intra-parenchymal brain injury.
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Keywords: Brain, Congenital heart disease, MRI, Newborn, Venography, congenital heart disease, newborn, brain, venography, Predictive Value of Tests, Age Factors, Humans, Male, Cardiac Surgical Procedures/adverse effects, Time Factors, Female, Retrospective Studies, Infant, Newborn, Risk Factors, Magnetic Resonance Angiography, Treatment Outcome, Cardiopulmonary Bypass, Sinus Thrombosis, Intracranial/complications, Cerebral Angiography/methods, Phlebography, Heart Defects, Congenital/complications, Surgery, Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, Video-Audio Media, Journal Article
ISSN: 0022-5223
Publisher: Mosby Inc.
Note: Funding Information: The authors thank the Congenital Heart Disease Life Span Study Group of the Wilhelmina Children's Hospital, which includes the Department of Neonatology, Department of Pediatric Intensive Care, Department of Pediatric Cardiology, Department of Pediatric Cardiothoracic Surgery, Department of Pediatric Anesthesiology, Department of Obstetrics, Department of Radiology, Department of Medical Psychology, and Child Development and Exercise Centre. Publisher Copyright: © 2017 The American Association for Thoracic Surgery
(Peer reviewed)