Cerebral Blood Flow Following Hybrid Stage I Palliation in Infants with Hypoplastic Left Heart Syndrome
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.
KeywordsCongenital heart disease Hypoplastic left heart syndrome Neurodevelopment Hybrid
Congenital heart disease
Hypoplastic left heart syndrome
Patent ductus arteriosus
Mental development index
Psychomotor development index
Bayley scales of infant and toddler development, 3rd edition
Centimeters per second
Peak systolic velocity
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.
This study was supported in part by the Cardiovascular Research Program in The Heart Center at Nationwide Children’s Hospital, as well as the National Institute of Health NRSA F31NR011253 by the National Institute of Nursing Research. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
The authors have no other conflict of interest.
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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