Thorac Cardiovasc Surg 2022; 70(S 02): S67-S103
DOI: 10.1055/s-0042-1743025
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Perioperative Metabolic Changes in Neonates with Congenital Heart Disease Determined by MR Spectroscopy—A Prospective Case-Control Study

C. Steger
1   Center of MR Research, University Children's Hospital, Zürich, Switzerland
,
M. Feldmann
2   Child Development Center, University Children's Hospital, Zürich, Switzerland
,
J. Borns
3   Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
,
B. Latal
2   Child Development Center, University Children's Hospital, Zürich, Switzerland
,
U. Held
4   Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland, Zurich, Switzerland
,
A. Jakab
1   Center of MR Research, University Children's Hospital, Zürich, Switzerland
,
W. Knirsch
3   Pediatric Cardiology, University Children's Hospital, Zürich, Switzerland
,
R. Tuura
5   Center of MR Research, Zürich, Switzerland
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Background: Neonates born with severe type of congenital heart defects (CHD) are at risk for neurodevelopmental (ND) impairment. Cerebral magnetic resonance imaging (MRI) studies revealed altered brain development. Little is known about perioperative metabolic changes in neonates undergoing open-heart surgery and the relationship between altered metabolite ratios with neurodevelopmental outcome.

Method: In a single-center, prospective, clinical, cerebral MRI study, CHD patients (n = 90) were enrolled between 2009 and 2020 and compared with group of healthy neonates (n = 30). Two cerebral MRIs were performed before and after neonatal cardiac surgery and one cerebral MRI in the control group. MR protocol included H-proton MR spectroscopy. Short-TE single voxel point resolved (PRESS) sequences were acquired in two brain regions (basal ganglia and white matter). Spectra were then analyzed using an automated spectral fitting method. All metabolites were referenced to creatine (Cre): N-acetyl aspartate (NAA), choline (Cho), glutamate + glutamine (Glx), myoinositol (mI), and lactate. Metabolite ratios including NAA/Cho were calculated. ND outcome at 1 year of age was determined using the Bayley's grade III composite scores (motor, cognition, and language). Linear mixed effects models with metabolite ratios as outcome were used to test for correlation between altered metabolite ratios and ND outcome.

Results: Metabolite ratio of NAA/Cho was reduced in the white matter of CHD neonates compared with the healthy controls (white matter NAA/Cho model: study group [CHD or control] β estimate = −0.27, uncorrelated p-value of <0.001, correlated p-value of 0.004), while there was no evidence that other metabolites were altered. Reduced NAA/Cho did not correlate with the Bayley grade III composite scores measured at 1 year of age.

Conclusion: Reduced metabolite ratio of NAA/Cho may serve as a metabolic biomarker affecting brain maturation in neonates undergoing open-heart surgery, while the clinical impact on ND outcome after 1 year is rather limited and needs further research.



Publication History

Article published online:
12 February 2022

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