Objective: Early detection of the brain injury in neonates with TGA in the pre-surgery is crucial for both anesthetic and surgical strategies. The objective was to define the ballon atrioseptostomy invasiveness degree, identify emerged lesions.
Methods: The total of 36 term newborns, mean age 6,4 days (range 1-17) with d-TGA underwent brain MRI before arterial switch. Group 1: 22 newborns had brain MRI after BAS within 4,5 days average, 6 of them underwent additional MRI on the planned surgery day. Group 2: 14 neonates had MRI before BAS and 8 of them underwent MRI also after BAS. None of the neonates had evident clinical neurological deficit after BAS.
Apparent diffusion coefficient(ADC) was calculated before BAS in 7 visually non-affected brain regions most sensitive to hypoxic-ischemic injury and additionally in ischemic damaged brain regions after BAS.
Results: In group 1-17 newborns (77%, p<0,001) and 3 newborns (37,5%, p=0,062) in group 2 had brain injury after BAS. No brain injury in group 2 before BAS. White matter injury and focal strokes are the two types of lesions that often occur (53% and 18% accordingly, coexisting injury 29%). ADC of the BAS caused ischemic stroke, regardless location, remained low within 0,4-0,5x10-3mm2/s (p<0,05) during the first 4-5 days.
Conclusions: Acquire brain injury is caused by the BAS.The acute ischemia of the brain can be reversible so requires the surgery postponing and pharmacological neuroprotection. All newborns with TGA have to undergo brain MRI after BAS prior to arterial switch.