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

BACKGROUND: Little is known about the relationship between brain volumes and neurodevelopmental outcome at 2 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 magnetic resonance imaging (MRI) scans was carried out in 44 patients without genetic comorbidities and in 8 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, 43 +/- 4.5, 277 +/- 30, and 16.4 ml, respectively (interquartile range (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 with controls (GM: P = 0.017, deep GM: P = 0.012, and 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.