Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jun;131(6):e1765-70.
doi: 10.1542/peds.2012-3734. Epub 2013 May 20.

Usefulness of routine head ultrasound scans before surgery for congenital heart disease

Danielle R Rios  1 , Stephen E Welty, Julia K Gunn, John Beca, Charles G Minard, Michelle Goldsworthy, Lee Coleman, Jill V Hunter, Dean B Andropoulos, Lara S Shekerdemian
Affiliations

Usefulness of routine head ultrasound scans before surgery for congenital heart disease

Danielle R Rios et al. Pediatrics. 2013 Jun.

Abstract

Objective: The purpose of this study was to assess the utility of preoperative head ultrasound scan (HUS) in a cohort of newborns also undergoing preoperative MRI as part of a prospective research study of brain injury in infants having surgery for congenital heart disease (CHD).

Methods: A total of 167 infants diagnosed with CHD were included in this 3-center study. None of the patients had clinical signs or symptoms of preoperative brain injury, and all patients received both HUS and brain MRI before undergoing surgical intervention. HUS and MRI results were reported by experienced neuroradiologists who were blinded to any specific clinical details of the study participants. The findings of the individual imaging modes were compared to evaluate for the presence of brain injury.

Results: Preoperative brain injury was present on HUS in 5 infants (3%) and on MRI in 44 infants (26%) (P < .001). Four of the HUS showed intraventricular hemorrhage not seen on MRI, suggesting false-positive results, and the fifth showed periventricular leukomalacia. The predominant MRI abnormality was white matter injury (n = 32). Other findings included infarct (n = 16) and hemorrhage (n = 5).

Conclusions: Preoperative brain injury on MRI was present in 26% of infants with CHD, but only 3% had any evidence of brain injury on HUS. Among positive HUS, 80% were false-positive results. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD, and MRI may be a preferable tool when the assessment of these infants is warranted.

Keywords: MRI; brain imaging; congenital heart disease; head ultrasound; neonate.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Stroke on MRI scan. A right cortical stroke (white arrow) identified by a high-signal intensity on DWI (left), a low-signal intensity on T1-weighted imaging (middle), and increased signal intensity on T2-weighted imaging (right) on the MRI scan of an asymptomatic newborn. This finding on MRI resulted in delay of surgery for this patient who had a normal HUS.
See this image and copyright information in PMC

References

    1. Dittrich H, Bührer C, Grimmer I, Dittrich S, Abdul-Khaliq H, Lange PE. Neurodevelopment at 1 year of age in infants with congenital heart disease. Heart. 2003;89(4):436–441 - PMC - PubMed
    1. Bellinger DC, Wypij D, duPlessis AJ, et al. . Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg. 2003;126(5):1385–1396 - PubMed
    1. Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics. 2008;121(4). Available at: www.pediatrics.org/cgi/content/full/121/4/e759 - PubMed
    1. McGrath E, Wypij D, Rappaport LA, Newburger JW, Bellinger DC. Prediction of IQ and achievement at age 8 years from neurodevelopmental status at age 1 year in children with D-transposition of the great arteries. Pediatrics. 2004;114(5). Available at: www.pediatrics.org/cgi/content/full/114/5/e572 - PubMed
    1. Snookes SH, Gunn JK, Eldridge BJ, et al. . A systematic review of motor and cognitive outcomes after early surgery for congenital heart disease. Pediatrics. 2010;125(4). Available at: www.pediatrics.org/cgi/content/full/125/4/e818 - PubMed

Publication types