Cerebral Sinus Venous Thrombosis in Infants after Surgery for Congenital Heart Disease - 15/09/22

Doi : 10.1016/j.jpeds.2022.05.056

Dana B. Harrar, MD, PhD ^1,^{^{∗
Contributed equally.}}, Margaret Goss, NP ^1,^{^{∗
Contributed equally.},}^{^{†
Present address: Department of Neurology, Dell Children's Medical Center, Austin, TX.}}, Mary T. Donofrio, MD ², Jonathan Murnick, MD, PhD ³, Justus G. Reitz, MD ^4,^{^{‡
Present address: Division of Prenatal Medicine and Fetal Therapy, University Hospital Giessen and Marburg, Giessen, Germany.}}, Anqing Zhang, PhD ⁵, Yaser Diab, MBBS ⁶, Jennifer Meldau, NP ⁶, Pranava Sinha, MD ⁴, Can Yerebakan, MD ⁴, Jessica L. Carpenter, MD ^1,^{^{§
Present address: Division of Pediatric Neurology, University of Maryland School of Medicine, Baltimore, MD.}}
¹ Division of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC
² Department of Cardiology, Children's National Hospital, Washington, DC
³ Department of Radiology, Children's National Hospital, Washington, DC
⁴ Cardiovascular Surgery, Children's National Hospital, Washington, DC
⁵ Biostatistics and Study Methodology, Children's National Hospital, Washington, DC
⁶ Division of Hematology, Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC

Abstract

Objective

To determine the prevalence of and risk factors for cerebral sinus venous thrombosis (CSVT) in neonates undergoing congenital heart disease (CHD) repair.

Study design

Neonates who had CHD repair with cardiopulmonary bypass and postoperative brain magnetic resonance imaging (MRI) between 2013 and 2019 at a single tertiary care center were identified from institutional databases. Demographic, clinical, and surgical data were abstracted from these databases and from the medical record; 278 neonates with CHD had cardiopulmonary bypass, 184 of whom had a postoperative brain MRI.

Results

Eight patients (4.3%) had a CSVT. Transposition of the great arteries with an intact ventricular septum (P < .01) and interrupted aortic arch (P = .02) were associated with an increased risk for CSVT. Other risk factors for CSVT included cross-clamp time (98 [IQR, 77.5-120] minutes vs 67 [IQR, 44-102] minutes; P = .03), units of platelets (3.63 [IQR, 3-4] vs 2.17 [IQR, 1-4]; P < .01) and packed red blood cells (0.81 [IQR, 0.25-1] vs 1.21 [IQR, 1-1]; P = .03) transfused intraoperatively, and time between surgery and MRI (10 [IQR, 7-12.5] days vs 20 [IQR, 12-35] days; P < .01). Five patients (62.5%) were treated with anticoagulation. All patients had complete or partial resolution of their CSVT, regardless of treatment.

Conclusions

Brain MRI after cardiopulmonary bypass in neonates revealed a low prevalence of CSVT (4.3%). Further studies are needed to establish best practices for surveillance, prevention, and treatment of CSVT in this population.

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Keywords : cardiac surgery, magnetic resonance imaging, magnetic resonance venography

Abbreviations : CHD, CoA, CSVT, D-TGA-IVS, MRI, MRV, PSOM

Plan

Methods

Results

Discussion

The authors declare no conflicts of interest.

Portions of this study have been presented as a virtual poster at the International Pediatric Stroke Organization Congress, July 17-20, 2021, Vienna, Austria, as a virtual platform presentation at the Annual Meeting of the Child Neurology Society-International Child Neurology Association, October 19-23, 2020, San Diego, California, and as a poster at the Annual Scientific Sessions of the Cardiac Neurodevelopmental Outcome Collaborative, October 11-13, 2019, Toronto, Ontario, Canada.

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Vol 248

P. 59 - septembre 2022 Retour au numéro

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Cerebral Sinus Venous Thrombosis in Infants after Surgery for Congenital Heart Disease - 15/09/22

Abstract

Objective

Study design

Results

Conclusions

Plan

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