4 years ago

Clinical and neuroimaging characteristics of cerebral sinovenous thrombosis in neonates undergoing cardiac surgery

Neonates with congenital heart disease may have an increased risk of cerebral sinovenous thrombosis (CSVT), but incidence rates are lacking. This study describes the clinical and neuroimaging characteristics of CSVT 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 CSVT. Clinical characteristics were compared between CSVT positive and CSVT negative neonates. Results Postoperatively, CSVT 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 CSVT positive than CSVT negative neonates (P 0.025). CSVT positive neonates spent more time at the intensive care unit preoperatively (P 0.001), had lower weight (P 0.024) and lower postmenstrual age (P 0.030) at surgery and prolonged use of a central venous catheter (P 0.023) and a catheter placed in the internal jugular vein more often (P 0.039). Surgical and postoperative factors were not different between new postoperative CSVT positive and CSVT negative neonates. Conclusions CSVT might be more common than previously understood in neonates undergoing cardiac surgery. In our study, CSVT was associated with higher risk of additional intra-parenchymal brain injury.

Publisher URL: www.sciencedirect.com/science

DOI: S0022522317324261

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