Pediatric Cardiology

, Volume 39, Issue 4, pp 837–843 | Cite as

Cerebral Blood Flow Following Hybrid Stage I Palliation in Infants with Hypoplastic Left Heart Syndrome

  • Sharon L. Cheatham
  • Joanne L. Chisolm
  • Nicole O’Brien
Original Article

Abstract

Hypoplastic left heart syndrome (HLHS) palliation may result in altered cerebral blood flow with subsequent neurodevelopmental implications. The purpose of the study was to assess blood flow in the middle cerebral artery (MCA) and investigate the relationship with early neurodevelopmental outcomes in infants with HLHS after hybrid stage I. Transcranial Doppler (TCD) was performed to obtain peak systolic, end-diastolic, and mean velocities, as well as pulsatility index of the MCA in infants with HLHS (n = 18) at baseline and at 2, 4, and 6 months of age. Developmental assessment was performed at 6 months of age. Results of TCD and development were compared to healthy control subjects (n = 6) and normative data. Overall, peak systolic velocity (p = 0.0031), end-diastolic velocity (p < 0.0001), and mean velocity (p < 0.0001) were significantly lower and pulsatility index (p = 0.0011) significantly higher in the HLHS group compared to the control group. A significant increase in change over time was noted for peak systolic velocity (p < 0.0016) and mean velocity (p < 0.0046). There was no significant correlation between TCD variables and development scores. TCD values in 5–6 months old infants with HLHS who undergo hybrid stage I palliation had consistently lower blood flow velocities than control infants; however, pulsatility index was slightly higher. No correlation between TCD measurements and measures of cognitive, language, and motor skills were noted.

Keywords

Congenital heart disease Hypoplastic left heart syndrome Neurodevelopment Hybrid 

Abbreviations

CHD

Congenital heart disease

HLHS

Hypoplastic left heart syndrome

PDA

Patent ductus arteriosus

MDI

Mental development index

PDI

Psychomotor development index

Bayley-III

Bayley scales of infant and toddler development, 3rd edition

Cm/s

Centimeters per second

PSV

Peak systolic velocity

EDV

End-diastolic velocity

MV

Mean velocity

PI

Pulsatility index

Notes

Authors Contributions

Sharon L. Cheatham: Dr. Cheatham conceptualized and designed the study, coordinated and provided data collection for both groups, carried out the initial analyses, prepared the manuscript, and approved the final manuscript as submitted. Joanne L. Chisolm: Ms. Chisolm coordinated data collection, critically reviewed the manuscript for important intellectual content, and approved the final manuscript as submitted. Nicole O’Brien: Dr. O’Brien provided data collection for the HLHS group, critically reviewed and revised the manuscript for important intellectual content, and approved the final manuscript as submitted.

Compliance with Ethical Standards

Conflict of interest

The authors have no other conflict of interest.

Ethical Approval

This study was approved by the Institutional Review Board and has therefore been performed in accordance with ethical standards. Informed consent was obtained on all subjects prior to their inclusion in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Heart CenterNationwide Children’s HospitalColumbusUSA
  2. 2.Division of Critical Care MedicineNationwide Children’s HospitalColumbusUSA
  3. 3.The Ohio State UniversityColumbusUSA

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