All issues > Volume 44(5); 2001

Original Article

J Korean Pediatr Soc. 2001;44(5):533-544. Published online May 15, 2001.

Neuro-developmental Assessment of Patients with Transposition of the Great Arteries by Localized 1H-Magnetic Resonance Spectroscopy

Ki-Soo KS Kim², Jee-Yeon JY Min¹, So Young SY Yoon², Young Hwue YH Kim², Jae Kon JK Ko², In Sook IS Park², Ki-Soo KS Kim², Dong Man DM Seo³, Sang-Tae ST Kim⁴, Jung Hee JH Lee⁴, In Kyung IK Sung¹

¹Department of Pediatrics, St. Mary`s Hospital, The Catholic University of Korea, Seoul, Korea
²Departments of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
³Departments of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
⁴NMR Laboratory, Asan Institute for Life Sciences, Seoul, Korea

Correspondence In Sook IS Park ,Email: ispark@www.amc.seoul.kr

Abstract

Purpose
: The purpose of this study was to evaluate the hemodynamic effect of transposition of the great arteries(TGA) on neuro-development by measuring the cerebral metabolites before and 1 year after open heart surgery(OHS) by localized in vivo 1H-magnetic resonance spectroscopy(1H- MRS) along with Bayley scales of infants development II(BSID II).
Methods
: Full-term newborns(N=13) with TGA and intact ventricular septum were examined 1H-MRS before OHS. Follow-up MRS and neuro-developmental examination by BSID II were performed in 9 patients at 12 months of age. Normal newborns(N=22) and infants(N=13, ages=9- 36 months) were included for comparison. Image guided STEAM-spectra were obtained from the parietal white matter(PWM) and occipital gray matter(OGM) regions with proton brain examination(PROBE). All spectroscopic raw data were processed and the values of the NAA/Cr, Cho/Cr, mI/Cr and NAA/Cho ratios were calculated.
Results
: The Values of NAA/Cr and NAA/Cho were lower in PWM and OGM, and Cho/Cr and mI/ Cr were higher in OGM from infants with TGA than from normal infants, suggesting that the abnormal hemodynamics of TGA in fetal life may have influenced neuro-development. The follow-up MRS examinations conducted at 12 months also showed high Cho/Cr and low NAA/Cho in PWM. All abnormal metabolite ratios from OGM in TGA newborns were normalized by 12 months. The results of BSID II showed relatively delayed mental development, especially language area than psychomotor development.
Conclusion
: The cerebral metabolism in infants with TGA has already been damaged prior to OHS and was not normalized by 12 months. However, the exact cause of the impaired metabolism is still not yet determined from this study; it may be due to the prenatal relative hypoxemia of the brain or OHS itself.

Keywords :Transposition of the great arteries, Magnetic resonance spectroscopy, Neuro-development