The Cardiothoracic Surgeon (Jan 2025)

Is routine preoperative head ultrasound screening before congenital cardiac surgery mandatory?

  • Shawana Farooq,
  • Hanan Rashid Abu Hassan,
  • Omai Mohammed AlSassi,
  • Tarek Alfawzan,
  • Abdullah Eltayeb,
  • Seifeldin Mohamed,
  • Suffura Rafique,
  • Ghaida Mohammed Ali,
  • Tarek Jamal Alanezi,
  • Ali Hussain Alharbi,
  • Brahim Tabarki,
  • Abdullah Al Wadai

DOI
https://doi.org/10.1186/s43057-024-00143-z
Journal volume & issue
Vol. 33, no. 1
pp. 1 – 7

Abstract

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Abstract Background The practice of routine preoperative head ultrasound (HUS) screening for infants and neonates undergoing surgery for congenital heart disease has been widely adopted; however, its usefulness is still unclear. Therefore, this study aimed to determine the prevalence of preoperative HUS abnormalities in neonates and infants with congenital heart disease, its association with postoperative neurological outcomes, and its sensitivity and specificity in detecting preoperative abnormalities. This retrospective cohort study was conducted between 2015 and 2022 at a tertiary referral center. The study included 596 children who were scheduled for cardiac surgery for congenital heart disease and who had preoperative HUS. Results The prevalence of preoperative HUS abnormalities was 23% (n = 137). There were no differences in the baseline characteristics between patients with normal and abnormal HUS. The most common abnormality reported by HUS was intraventricular hemorrhage (IVH) (n = 65, 47.45%). Surgery was done in 417 (78.53%) with no IVH vs. 50 (76.92%) with IVH (P = 0.766). Mortality was statistically not significantly higher in patients with abnormal HUS (14% vs. 8%; P = 0.092). Twenty-seven patients developed new postoperative neurological complications (5.78%), with no difference between the groups (5.7% vs. 6.1%, P = 0.893). Preoperative neurological abnormalities (OR: 1.24 (95% CI: 1.08–1.41); P = 0.002) and intrauterine growth retardation (OR: 5.37 (95% CI: 1.61–17.88), P = 0.006) were significantly associated with new postoperative neurological events. The sensitivity of HUS compared with that of MRI was 51%, and the specificity was 83%. Conclusions The HUS showed a high percentage of abnormal findings in children with congenital heart disease; however, these findings were not necessarily correlated with the outcome. The study findings do not support the routine use of HUS for neonates and infants undergoing surgery for congenital heart disease. Abnormal HUS findings did not significantly impact surgical rates or postoperative outcomes.

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