Pediatric Neurology
Volume 29, Issue 2 , Pages 99-110 , August 2003

Serial proton magnetic resonance spectroscopy of the brain in children undergoing cardiac surgery

  • Stephen Ashwal, MD

      Affiliations

    • Corresponding Author InformationCommunications should be addressed to:Dr. Ashwal; Department of Pediatrics; Coleman Pavilion, Loma Linda University School of Medicine; 11175 Campus Street, Loma Linda, CA 92350, USA.
    • Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA ,USA
    • Corresponding Author InformationCommunications should be addressed to:Dr. Ashwal; Department of Pediatrics; Coleman Pavilion, Loma Linda University School of Medicine; 11175 Campus Street, Loma Linda, CA 92350, USA.
  • ,
  • Barbara A Holshouser, PhD

      Affiliations

    • Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA ,USA
  • ,
  • Michael J del Rio, MD

      Affiliations

    • Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA ,USA
  • ,
  • Karen A Tong, MD

      Affiliations

    • Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA ,USA
  • ,
  • Richard L Applegate, MD

      Affiliations

    • Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA ,USA
  • ,
  • Leonard L Bailey, MD

      Affiliations

    • Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA ,USA

Received 19 September 2002 ,Accepted 13 January 2003.

References 

  1. Benson D. Changing profile of congenital heart disease. Pediatrics. 1989;83:790–791
  2. Ferry P. Neurologic sequelae of open heart surgery in children (An irritating question). Am J Dis Child. 1990;144:369–373
  3. Jonas R, Newburger J, Volpe J. Brain injury and pediatric cardiac surgery. Boston, MA: Butterworth-Heineman; 1995;
  4. Kirkham FJ. Recognition and prevention of neurological complications in pediatric cardiac surgery. Pediatr Cardiol. 1998;19:331–345
  5. du Plessis AJ. Neurologic disorders associated with cardiac disease. In:  Swaiman KF,  Ashwal S editor. Pediatric neurology principles and practice. St. Louis: Mosby; 1999;p. 1385–1402
  6. Dexter F, Kern FH, Hindman BJ, Greeley WJ. The brain mostly uses dissolved oxygen during hypothermic cardiopulmonary bypass. Ann Thorac Surg. 1997;63:1725–1729
  7. Jonassen AE, Quaegebeur JM, Young WL. Cerebral blood flow velocity in pediatric patients is reduced after cardiopulmonary bypass with profound hypothermia. J Thorac Cardiovascular Surg. 1995;110:934–943
  8. Astudillo R, van der Linden J, Ekroth R, Scallan M, Lincoln C. Absent diastolic cerebral blood flow velocity after circulatory arrest but not after low flow in infants. Ann Thorac Surg. 1993;56:515–519
  9. Poulos ND, Mollitt DL. The nature and reversibility of hypothermia induced alterations of blood viscosity. J Trauma. 1991;31:996–998
  10. Tateishi N, Suzuki Y, Soutani M, Maeda N. Flow dynamics of erythrocytes in microvessels of isolated rabbit mesentery (Cell free layer and flow resistance). J Biomechanics. 1994;27:1119–1125
  11. Aly Hassan A, Lochbuehler H, Frey L, Messmer K. Global tissue oxygenation during normovolemic hemodilution in young-children. Paediatr Anaesth. 1997;7:197–204
  12. Eke CC, Gundry SR, Baum MF, Chinnock RE, Razzouk AJ, Bailey LL. Neurologic sequelae of deep hypothermic circulatory arrest in cardiac transplant infants. Ann Thorac Surg. 1996;61:783–788
  13. Shevell MI, Ashwal S, Novotny E. Proton magnetic resonance spectroscopy (Clinical applications in children with nervous system diseases). Semin Pediatr Neurol. 1999;6:68–77
  14. Holshouser BA, Ashwal S, Shu S, Hinshaw DB. Proton MR spectroscopy in children with acute brain injury (Comparison of short and long echo time acquisitions). J Magn Reson Imaging. 2000;11:9–19
  15. Ashwal S, Holshouser BA, Shu SK, et al.  Predictive value of proton MR spectroscopy in pediatric closed head injury. Pediatr Neurol. 2000;23:114–125
  16. Ashwal S, Holshouser BA, Hinshaw DB, Schell RM, Bailey L. Proton magnetic resonance spectroscopy in the evaluation of children with congenital heart disease and acute central nervous system injury. J Thorac Cardiovasc Surg. 1996;112:403–414
  17. Provencher SW. Estimation of metabolite concentrations from localized in vivo proton NMR spectra. Magn Reson Med. 1993;30:672–679
  18. Holmes G, Rowe J, Hafford J, Schmidt R, Testa A, Zimmerman A. Prognostic value of the electroencephalogram in neonatal asphyxia. Electroenceph Clin Neurophys. 1982;53:60–72
  19. Fiser DH. Outcome evaluations as measures of quality in pediatric intensive care. Pediatr Clin North Am. 1994;41:1423–1438
  20. Danielsen ER, Ross B. Magnetic resonance spectroscopy diagnosis of neurological diseases. New York: Marcel Dekker; 1999;
  21. Brooks WM, Stidley CA, Petropoulos H. Metabolic and cognitive response to human traumatic brain injury (A quantitative proton magnetic resonance study). J Neurotrauma. 2000;17:629–640
  22. Johnston MV. Hypoxic and ischemic disorders of infants and children. Lecture for 38th meeting of Japanese Society of Child Neurology, Tokyo, Japan, July 1996. Brain Dev. 1997;19:235–239
  23. Pu Y, Li Q-F, Zeng C-M, et al.  Increased detectability of alpha brain glutamate/glutamine in neonatal hypoxic-ischemic encephalopathy. AJNR. 2000;21:203–212
  24. Groenendaal F, Roelants-Van Rijn AM, van Der Grond J, Toet MC, de Vries LS. Glutamate in cerebral tissue of asphyxiated neonates during the first week of life demonstrated in vivo using proton magnetic resonance spectroscopy. Biol Neonate. 2001;79:254–257
  25. Menache CC, du Plessis AJ, Wessel DL, Jonas RA, Newburger JW. Current incidence of acute neurologic complications after open-heart operations in children. Ann Thorac Surg. 2002;73:1752–1758
  26. Schmitt B, Bauersfeld U, Fanconi S, et al.  The effect of the N-methyl-D-aspartate receptor antagonist dextromethorphan on perioperative brain injury in children undergoing cardiac surgery with cardiopulmonary bypass (Results of a pilot study). Neuropediatrics. 1997;28:191–197
  27. Tseng EE, Brock MV, Kwon CC, et al.  Increased intracerebral excitatory amino acids and nitric oxide after hypothermic circulatory arrest. Ann Thorac Surg. 1999;67:371–376
  28. Baumgartner WA, Walinsky PL, Salazar JD, et al.  Assessing the impact of cerebral injury after cardiac surgery (Will determining the mechanism reduce this injury?). Ann Thorac Surg. 1999;67:1871–1873
  29. Redmond JM, Gillinov AM, Zehr KJ, et al.  Glutamate excitotoxicity (A mechanism of neurologic injury associated with hypothermic circulatory arrest). J Thorac Cardiovasc Surg. 1994;107:776–786
  30. Rimpilainen J, Pokela M, Kiviluoma K, et al.  The N-methyl-D-aspartate antagonist memantine has no neuroprotective effect during hypothermic circulatory arrest (A study in the chronic porcine model). J Thorac Cardiovasc Surg. 2001;121:957–968
  31. Aoki M, Nomura F, Stromski ME, et al.  Effects of MK-801 and NBQX on acute recovery of piglet cerebral metabolism after hypothermic circulatory arrest. J Cereb Blood Flow Metab. 1994;14:156–165
  32. Anttila V, Rimpilainen J, Pokela M, et al.  Lamotrigine improves cerebral outcome after hypothermic circulatory arrest (A study in a chronic porcine model). J Thorac Cardiovasc Surg. 2001;121:597–598
  33. Baslow MH. Functions of N-acetyl-L-aspartate and N-acetyl-L-aspartylglutamate in the vertebrate brain (Role in glial cell-specific signaling). J Neurochem. 2000;75:453–459
  34. Rubin Y, Cecil K, Wehrli S, McIntosh TK, Lenkinski RE, Smith DH. High-resolution 1H NMR spectroscopy following experimental brain trauma. J Neurotrauma. 1997;14:441–449
  35. Mehta V, Namboodiri MA. N-acetylaspartate as an acetyl source in the nervous system. Brain Res Mol Brain Res. 1995;31:151–157
  36. Taylor DL, Davies SE, Obrenovitch TP, et al.  Investigation into the role of N-acetylaspartate in cerebral osmoregulation. J Neurochem. 1995;65:275–281
  37. Dijkhuizen RM, de Graaf RA, Tulleken KA, Nicolay K. Changes in the diffusion of water and intracellular metabolites after excitotoxic injury and global ischemia in neonatal rat brain. J Cereb Blood Flow Metab. 1999;19:341–349
  38. Miller SL, Daikhin Y, Yudkoff M. Metabolism of N-acetyl-L-aspartate in rat brain. Neurochem Res. 1996;21:615–618
  39. Tyson RL, Sutherland GR. Labeling of N-acetylaspartate and N-acetylaspartylglutamate in rat neocortex, hippocampus and cerebellum from 1-13C glucose. Neurosci Lett. 1998;251:181–184
  40. De Stefano N, Matthews PM, Arnold DL. Reversible decreases in N-acetylaspartate after acute brain injury. Magn Reson Med. 1995;34:721–727
  41. Robertson NJ, Lewis RH, Cowan FM, et al.  Early increases in brain myo-inositol measured by proton magnetic resonance spectroscopy in term infants with neonatal encephalopathy. Pediatr Res. 2001;50:692–700
  42. NollertG, Jonas RA, Reichart B. Optimizing cerebral oxygenation during cardiac surgery: A review of experimental and clinical investigations with near infrared spectrophotometry. Thorac Cardiovasc Surg 2000;48:247-53
  43. Filgueiras CL, Ryner L, Ye J, et al.  Cerebral protection during moderate hypothermic circulatory arrest (Histopathology and magnetic resonance spectroscopy of brain energetics and intracellular pH in pigs). J Thorac Cardiovasc Surg. 1996;112:1073–1080
  44. Kawata H, Fackler JC, Tsuji MK, et al.  Recovery of cerebral blood flow and energy state in piglets after hypothermic circulatory arrest versus recovery after low-flow bypass. J Thorac Cardiovasc Surg. 1993;106:671–685
  45. Harris DN, Wilson JA, Taylor-Robinson SD, Taylor KM. Magnetic resonance spectroscopy of high-energy phosphates and lactate immediately after coronary artery bypass surgery. Perfusion. 1998;13:328–333
  46. Bellinger DC, Jonas RA, Rappaport LA, et al.  Developmental and neurologic status of children after heart surgery hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med. 1995;332:549–555
  47. Swain JA, McDonald TJ, Griffith PK, Balaban RS, Clark RE, Ceckler T. Low-flow hypothermic cardiopulmonary bypass protects the brain. J Thorac Cardiovasc Surg. 1991;102:76–83
  48. Fox LS, Blackstone EH, Kirklin JW, Bishop SP, Bergdahl LA, Bradley EL. Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypothermic cardiopulmonary bypass. An experimental study. J Thorac Cardiovasc Surg. 1984;87:658–664
  49. Sakamoto T, Zurakowski D, Duebener LF, et al.  Combination of alpha-stat strategy and hemodilution exacerbates neurologic injury in a survival piglet model with deep hypothermic circulatory arrest. Ann Thorac Surg. 2002;73:180–189

PII: S0887-8994(03)00045-6

doi: 10.1016/S0887-8994(03)00045-6

Pediatric Neurology
Volume 29, Issue 2 , Pages 99-110 , August 2003