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Journal of the Korean Pediatric Society 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 Kim2, Jee-Yeon Min1, So Young Yoon2, Young Hwue Kim2, Jae Kon Ko2, In Sook Park2, Ki-Soo Kim2, Dong Man Seo3, Sang-Tae Kim4, Jung Hee Lee4, In Kyung 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
완전 대혈관 전위 환아에서 수소 자기 공명 분광법을 이용한 신경학적 발달 상태에 대한 고찰
김기수2, 민지연1, 윤소영2, 김영휘2, 고재곤2, 박인숙2, 김기수2, 서동만3, 김상태4, 이정희4, 성인경1
1가톨릭의대 성모병원 소아과
2울산의대 서울중앙병원 소아과
3울산의대 서울중앙병원 흉부외과
4아산생명과학연구소
Correspondence:  In Sook 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.
Key Words: Transposition of the great arteries, Magnetic resonance spectroscopy, Neuro-development


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