Reduction of brain volumes after neonatal cardiopulmonary bypass surgery in single ventricle congenital heart disease prior to Fontan completion

BACKGROUND: Little is known about the relationship between brain volumes and neurodevelopmental outcome at two years of age in children with single ventricle congenital heart disease (CHD). We hypothesized that reduced brain volumes may be associated with adverse neurodevelopmental outcome. METHODS: Volumetric segmentation of cerebral MRI scans was done in 44 patients without genetic comorbidities and in eight controls. Neurodevelopmental outcome was assessed with the Bayley-III scales. RESULTS: Gray matter (GM), deep GM, white matter (WM), and cerebrospinal fluid (CSF) volumes were 611±59 ml, 43±4.5 ml, 277±30 ml, and 16.4 ml (IQR 13.1, 23.3 ml). Children undergoing neonatal cardiopulmonary bypass surgery showed smaller deep GM (P=0.005) and WM (P=0.021) volumes. Brain volumes were smaller in patients compared to controls (GM: P=0.017, deep GM: P=0.012, WM: P=0.015), whereas CSF volumes were greater (P=0.014). Of all intracranial volumes, only CSF volume was associated with neurodevelopmental outcome, accounting for 21% (P=0.011) of variability in the cognitive composite score when combined with common risk factors in a multivariable analysis. CONCLUSION: Increased CSF volume represents a significant risk factor for neurodevelopmental impairment in children with single ventricle CHD. Later assessments are warranted to determine the prognostic role of intracranial volumes for long-term outcome.Pediatric Research accepted article preview online, 21 August 2017. doi:10.1038/pr.2017.203.