Effects of hemodynamic alterations and oxygen saturation on cerebral perfusion in congenital heart disease

Alexandra De Silvestro; Giancarlo Natalucci; Maria Feldmann; Cornelia Hagmann; Thi Dao Nguyen; Seline Coraj; Andras Jakab; Raimund Kottke; Beatrice Latal; Walter Knirsch; Ruth Tuura

doi:10.1038/s41390-024-03106-6

Effects of hemodynamic alterations and oxygen saturation on cerebral perfusion in congenital heart disease

Pediatr Res. 2024 Mar 4. doi: 10.1038/s41390-024-03106-6. Online ahead of print.

Authors

Alexandra De Silvestro^{1

2

3

4}, Giancarlo Natalucci^{4

5

6}, Maria Feldmann^{3

7}, Cornelia Hagmann^{3

8}, Thi Dao Nguyen^{4

6}, Seline Coraj^{4

5

6}, Andras Jakab^{2

3

4}, Raimund Kottke^{3

9}, Beatrice Latal^{3

4

7}, Walter Knirsch^#^{1

3

4}, Ruth Tuura^#^{10

11

12}

Affiliations

¹ Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
² Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland.
³ Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
⁴ University of Zurich, Zurich, Switzerland.
⁵ Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
⁶ Newborn Research Zurich, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
⁷ Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.
⁸ Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
⁹ Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.
¹⁰ Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland. ruth.tuura@kispi.uzh.ch.
¹¹ Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland. ruth.tuura@kispi.uzh.ch.
¹² University of Zurich, Zurich, Switzerland. ruth.tuura@kispi.uzh.ch.

^# Contributed equally.

PMID: 38438551
DOI: 10.1038/s41390-024-03106-6

Abstract

Background: Patients with severe congenital heart disease (CHD) are at risk for neurodevelopmental impairment. An abnormal cerebral blood supply caused by the altered cardiac physiology may limit optimal brain development. The aim of this study was to evaluate the effect of a systemic-to-pulmonary shunt, aortic arch obstruction and arterial oxygen saturation on cerebral perfusion in patients with severe CHD.

Methods: Patients with severe CHD requiring cardiac surgery within the first six weeks of life, who underwent pre- and/or postoperative brain magnetic resonance imaging (MRI), and healthy controls with one postnatal scan were included. Cerebral perfusion in deep and cortical gray matter was assessed by pseudocontinuous arterial spin labeling MRI.

Results: We included 59 CHD and 23 healthy control scans. The presence of a systemic-to-pulmonary shunt was associated with decreased perfusion in cortical (p = 0.003), but not in deep gray matter (p = 0.031). No evidence for an effect of aortic arch obstruction and arterial oxygen saturation on cerebral perfusion was found. After adjusting for hemodynamic and oxygen saturation parameters, deep (p = 0.018) and cortical (p = 0.012) gray matter perfusion was increased in patients with CHD compared to controls.

Conclusion: We detected regional differences in compensation to the cerebral steal effect in patients with severe CHD.

Impact: Patients with severe congenital heart disease (CHD) have altered postnatal brain hemodynamics. A systemic-to-pulmonary shunt was associated with decreased perfusion in cortical gray matter but preserved perfusion in deep gray matter, pointing towards regional differences in compensation to the cerebral steal effect. No effects of aortic arch obstruction and arterial oxygenation on cerebral perfusion were seen. Cerebral perfusion was increased in patients with CHD compared to healthy controls after adjusting for hemodynamic alterations and oxygen saturation. To improve neuroprotection and neurodevelopmental outcomes, it is important to increase our understanding of the factors influencing cerebral perfusion in neonates with severe CHD.