Instant Detection of Cerebral Blood Flow Changes in Infants with Congenital Heart Disease During Transcatheter Interventions

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Jun 19

PMID 38892827

Authors

Martin Leth-Olsen

Gaute Dohlen

Hans Torp

Siri Ann Nyrnes

Affiliations

Soon will be listed here.

Abstract

: Transcatheter interventions are increasingly used in children with congenital heart disease. However, these interventions can affect cardiac output and cerebral circulation. In this pilot study, we aimed to investigate the use of NeoDoppler, a continuous transfontanellar cerebral Doppler monitoring system, to evaluate the impact of transcatheter interventions on cerebral circulation. : Nineteen participants under one year of age (mean age 3.5 months) undergoing transcatheter cardiac interventions were prospectively included. Transfontanellar cerebral Doppler monitoring with the NeoDoppler system was initiated after intubation and continued until the end of the procedure. : Instant detection of changes in cerebral blood flow were observed across a spectrum of transcatheter interventions. Balloon aortic valvuloplasty demonstrated temporary cessation of cerebral blood flow during balloon inflation. Increase in cerebral diastolic blood flow velocity and decreased pulsatility were observed during patent ductus arteriosus occlusion. Changes in cerebral blood flow patterns were detected in two patients who encountered complications during their transcatheter interventions. There was no significant change in Doppler parameters before and after the interventions for the entire patient group. High quality recordings were achieved in 87.3% of the monitoring period. : Continuous transfontanellar cerebral Doppler is feasible in monitoring cerebral hemodynamic trends and shows instantaneous changes associated with interventions and complications. It could become a useful monitoring tool during transcatheter interventions in infants.

References

Kenny D, Hijazi Z . Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res. 2017; 120(6):1015-1026. DOI: 10.1161/CIRCRESAHA.116.309185. View

Keusters L, Purna J, Deshpande P, Mertens L, Shah P, McNamara P . Clinical validity of systemic arterial steal among extremely preterm infants with persistent patent ductus arteriosus. J Perinatol. 2020; 41(1):84-92. DOI: 10.1038/s41372-020-0663-8. View

Kim E, Lee J, Song I, Kim H, Jang Y, Kim W . Potential Role of Transfontanelle Ultrasound for Infants Undergoing Modified Blalock-Taussig Shunt. J Cardiothorac Vasc Anesth. 2018; 32(4):1648-1654. DOI: 10.1053/j.jvca.2017.12.017. View

Zaleski K, Kussman B . Near-Infrared Spectroscopy in Pediatric Congenital Heart Disease. J Cardiothorac Vasc Anesth. 2019; 34(2):489-500. DOI: 10.1053/j.jvca.2019.08.048. View

Leth-Olsen M, Dohlen G, Torp H, Nyrnes S . Detection of Cerebral High-Intensity Transient Signals by NeoDoppler during Cardiac Catheterization and Cardiac Surgery in Infants. Ultrasound Med Biol. 2022; 48(7):1256-1267. DOI: 10.1016/j.ultrasmedbio.2022.02.021. View

Saliba E, Chantepie A, Gold F, Marchand M, Pourcelot L, Laugier J . Intraoperative measurements of cerebral haemodynamics during ductus arteriosus ligation in preterm infants. Eur J Pediatr. 1991; 150(5):362-5. DOI: 10.1007/BF01955941. View

El-Said H, Bratincsak A, Foerster S, Murphy J, Vincent J, Holzer R . Safety of percutaneous patent ductus arteriosus closure: an unselected multicenter population experience. J Am Heart Assoc. 2013; 2(6):e000424. PMC: 3886754. DOI: 10.1161/JAHA.113.000424. View

Meliota G, Vairo U . Transcatheter Interventions for Neonates with Congenital Heart Disease: A Review. Diagnostics (Basel). 2023; 13(16). PMC: 10453781. DOI: 10.3390/diagnostics13162673. View

van der Laan M, Verhagen E, Bos A, Berger R, Kooi E . Effect of balloon atrial septostomy on cerebral oxygenation in neonates with transposition of the great arteries. Pediatr Res. 2012; 73(1):62-7. DOI: 10.1038/pr.2012.147. View

10.

Mitra S, de Boode W, Weisz D, Shah P . Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews. Cochrane Database Syst Rev. 2023; 4:CD013588. PMC: 10091483. DOI: 10.1002/14651858.CD013588.pub2. View

11.

Ing R, Twite M . Toward Improved Neurodevelopmental Outcomes: The Role of Transfontanel Ultrasound Assessment of Cerebral Blood Flow in Infants Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth. 2018; 32(4):1655-1656. DOI: 10.1053/j.jvca.2018.01.034. View

12.

Devanagondi R, Peck D, Sagi J, Donohue J, Yu S, Pasquali S . Long-Term Outcomes of Balloon Valvuloplasty for Isolated Pulmonary Valve Stenosis. Pediatr Cardiol. 2016; 38(2):247-254. DOI: 10.1007/s00246-016-1506-4. View

13.

Mir M, Moore S, Wutthigate P, Simoneau J, Martinez D, Shemie S . Newborns with a Congenital Heart Defect and Diastolic Steal Have an Altered Cerebral Arterial Doppler Profile. J Pediatr. 2023; 257:113369. DOI: 10.1016/j.jpeds.2023.02.015. View

14.

Takaya Y, Akagi T, Kijima Y, Nakagawa K, Sano S, Ito H . Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. JACC Cardiovasc Interv. 2015; 8(4):600-6. DOI: 10.1016/j.jcin.2015.02.002. View

15.

Camfferman F, Goederen R, Govaert P, Dudink J, van Bel F, Pellicer A . Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review. Pediatr Res. 2020; 87(Suppl 1):50-58. PMC: 7098887. DOI: 10.1038/s41390-020-0777-x. View

16.

Cansaran Tanidir I, Ozturk E, Ozyilmaz I, Saygi M, Kiplapinar N, Haydin S . Near infrared spectroscopy monitoring in the pediatric cardiac catheterization laboratory. Artif Organs. 2014; 38(10):838-44. DOI: 10.1111/aor.12256. View

17.

Rodriguez R, Hosking M, Duncan W, Sinclair B, Teixeira O, Cornel G . Cerebral blood flow velocities monitored by transcranial Doppler during cardiac catheterizations in children. Cathet Cardiovasc Diagn. 1998; 43(3):282-90. DOI: 10.1002/(sici)1097-0304(199803)43:3<282::aid-ccd9>3.0.co;2-5. View

18.

Sathanandam S, Gutfinger D, OBrien L, Forbes T, Gillespie M, Berman D . Amplatzer Piccolo Occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams. Catheter Cardiovasc Interv. 2020; 96(6):1266-1276. PMC: 7754477. DOI: 10.1002/ccd.28973. View

19.

Barry O, Bouhout I, Turner M, Petit C, Kalfa D . Transcatheter Cardiac Interventions in the Newborn: JACC Focus Seminar. J Am Coll Cardiol. 2022; 79(22):2270-2283. DOI: 10.1016/j.jacc.2022.03.374. View

20.

de Vries J, Hoorntje T, Sreeram N . Neurophysiological effects of pediatric balloon dilatation procedures. Pediatr Cardiol. 2000; 21(5):461-4. DOI: 10.1007/s002460010110. View