The role of preoperative head ultrasound in the prediction of outcome in infants undergoing surgery for congenital heart surgery

Background; A significant proportion of infants undergoing open-heart surgery for congenital heart disease (CHD) manifest preoperative neurobehavioral abnormalities. MRI studies have demonstrated that cerebral injury can occur preoperatively. However, most centers only perform cerebral ultrasound (cUS) preoperatively. Its sensitivity in detecting cerebral abnormalities and predicting postoperative outcome has not been determined for this population.

Methods; Prospective cohort study on 282 infants who were operated before 12 months of age. cUS was obtained in 127 infants preoperatively. Neurological examination was performed preoperatively and at 1 year using the Bayley Scales of Infant Development II (mental developmental index MDI; psychomotor developmental index PDI).

Results; Abnormalities were detected in 55 infants (24%) and consisted of IVH (n=5, 2%), ventricular dilatation (n=11, 5%), periventricular flaring (grade 1 PVL; n=29, 13%) and other abnormalities (n=10, 4%). cUS abnormalities were not related to the type of heart defect (p=0.9), genetic disorder (p=0.6), the head circumference (p=0.5) or duration of surgery (p=0.2). However, infants with cUS abnormalities showed more preoperative neurological abnormalities (Mann Whitney p=0.01). cUS abnormalities were not related to neurodevelopmental outcome at 1 year, but preoperative neurological abnormalities did (MDI R: –0.56, PDI R: –0.58, neuroscore R: 0.58, all p<0.001).

Conclusion: Preoperative cUS does not correlate with preoperative neurological status and has limited predictive value for neurodevelopmental outcome. Thus, magnetic resonance imaging is a better tool should be used routinely in children with severe CHD.

neurological outcome - congenital heart disease - follow up