TY - JOUR
T1 - Clinical and neuroimaging characteristics of cerebral sinovenous thrombosis in neonates undergoing cardiac surgery
AU - Claessens, Nathalie H.P.
AU - Algra, Selma O.
AU - Jansen, Nicolaas J.G.
AU - Groenendaal, Floris
AU - de Wit, Esther
AU - Wilbrink, Alexander A
AU - Haas, Felix
AU - Schouten, Antonius N J Schouten
AU - Nievelstein, Rutger A.J.
AU - Benders, Manon J.N.L.
AU - de Vries, Linda S.
N1 - 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
PY - 2018/3
Y1 - 2018/3
N2 - 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 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.
AB - 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 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.
KW - Brain
KW - Congenital heart disease
KW - MRI
KW - Newborn
KW - Venography
KW - congenital heart disease
KW - newborn
KW - brain
KW - venography
KW - Predictive Value of Tests
KW - Age Factors
KW - Humans
KW - Male
KW - Cardiac Surgical Procedures/adverse effects
KW - Time Factors
KW - Female
KW - Retrospective Studies
KW - Infant, Newborn
KW - Risk Factors
KW - Magnetic Resonance Angiography
KW - Treatment Outcome
KW - Cardiopulmonary Bypass
KW - Sinus Thrombosis, Intracranial/complications
KW - Cerebral Angiography/methods
KW - Phlebography
KW - Heart Defects, Congenital/complications
UR - http://www.scopus.com/inward/record.url?scp=85036653655&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2017.10.083
DO - 10.1016/j.jtcvs.2017.10.083
M3 - Article
C2 - 29221746
SN - 0022-5223
VL - 155
SP - 1150
EP - 1158
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -