Changes of Brain Magnetic Resonance Imaging Findings After Congenital Aortic Arch Anomaly Repair Using Regional Cerebral Perfusion in Neonates and Young Infants

Background. The objective of this prospective study is to compare magnetic resonance imaging (MRI) findings before and after surgery for repairing congenital aortic arch anomalies using regional cerebral perfusion. Methods. Neurologic examinations that included brain MRI, brain sonography, and electroencephalograms were performed before and after surgery for congenital aortic arch anomalies and the accompanying intracardiac anomalies using regional cerebral perfusion in 11 neonates and young infants. Results. The median age at operation was 11 days (range, 5 to 46). The diagnoses included coarctation of the aorta with accompanying intracardiac anomalies (n = 10) and interruption of the aortic arch (n = 1). Aortic arch repair was performed using regional cerebral perfusion through the right innominate artery (regional perfusion time: 25.6 +/- 6.0 minutes) without cardiac arrest. Two patients had new postoperative lesions on postoperative brain MRI, and these were acute focal subdural hemorrhage (n = 1) and acute focal infarction (n = 1). However, they were without clinical significance. Periventricular leukomalacia was not observed on brain MRI. There was no significant change between the preoperative and postoperative findings on brain sonography and electroencephalograms. All the patients showed normal neurologic growth for a mean follow-up duration of 175.3 days (range: 25 to 497 days). Conclusions. There were newly developed lesions on the postoperative brain MRI in 2 of 11 patients, even though these patients showed normal brain sonography and electroencephalogram findings and normal neurologic development. Our regional cerebral perfusion protocol for aortic arch repair showed tolerable neurologic outcomes, and it did not induce periventricular leukomalacia. (Ann Thorac Surg 2010;90:1996-2000) (C) 2010 by The Society of Thoracic Surgeons