Brain abnormalities and neurodevelopmental delay in congenital heart disease: systematic review and meta-analysis

Khalil, Asma; Suff, Natalie; Thilaganathan, B.; Hurrell, Andrew J.; Cooper, Derek; Carvalho, J. S.

doi:10.1002/uog.12526

Cited by 163 publications

(156 citation statements)

References 69 publications

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“…Finally, we found similar MRI spectroscopic results to those previously reported for neonates [10] and third-trimester fetuses [11] with CHD, showing decreased mean NAA/Cho ratios in several brain areas. Concerning the association between the type of CHD and the degree of neurological injury, previous reports had already described more pronounced brain findings in specific types of CHD, particularly in HLHS [13,39]. In this study, we systematically subdivided CHD according to the expected brain oxygenation pattern, which allowed providing further conclusive evidence in support of this notion.…”

Section: Discussionsupporting

confidence: 63%

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

et al. 2015

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Objectives: We evaluated the hypothesis that in fetuses with congenital heart disease (CHD) there is a correlation between the expected pattern of in utero brain blood supply and the severity of neurodevelopmental impairment. Methods: A total of 58 fetuses with CHD and 58 controls underwent a Doppler ultrasound and fetal MRI at 36-38 weeks. Fetuses with CHD were divided into two functional classes: class A with an expected severe reduction in oxygenated brain blood supply (left outflow tract obstruction and transposition of great vessels) and class B with theoretically near-normal or mildly impaired oxygenated brain blood supply (other CHD). Head biometry and cerebroplacental Doppler were assessed by ultrasound, and brain volumetry, cortical development and metabolism by MRI. Results: Both class A and B CHD fetuses had significant differences in head biometry, brain perfusion, cortical development and brain metabolism compared with controls. However, there was a significant linear tendency for head biometry, cerebral Doppler, volumes, cortical sulcation and metabolic ratios across the three clinical groups, with signs of more severe brain alterations in type A CHD fetuses. Conclusions: All fetuses with CHD showed significant brain developmental changes, but differences were more pronounced in CHD associated with an expected severe reduction in oxygenated blood supply to the brain.

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Section: Discussionsupporting

confidence: 63%

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

et al. 2015

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“…Most cerebral findings in CHD newborns are mild, such as asymmetrical widened ventricles and increased extracerebral fluid. Neonatal MRI studies report delayed brain maturation and signs of cerebral atrophy [8]. These findings led to the hypothesis that cerebral damage or altered cerebral development in fetuses with CHD already starts in the prenatal period, due to abnormal flow and oxygenation patterns [9].…”

Section: Introductionmentioning

confidence: 99%

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

et al. 2019

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Objective: The aim of our study is to explore whether the cerebral growth is delayed in fetuses with congenital heart defects (CHD) in the second and early third trimester. Methods: A prospective cohort study was conducted in 77 CHD cases, with 75 healthy controls. 3D cerebral volume acquisition was performed sequentially. The volumes of the fetal hemicerebrum and extracerebral fluid were compared by linear regression analysis, and the Sylvian fissure was measured. Results: Between 19 and 32 weeks of gestation, 158 measurements in cases and 183 measurements in controls were performed (mean 2.2/subject). The volume growth of the hemicerebrum (R² = 0.95 vs. 0.95; p = 0.9) and the extracerebral fluid (R² = 0.84 vs. 0.82, p = 0.9) were similar. Fetuses with abnormal oxygen delivery to the brain have a slightly smaller brain at 20 weeks of gestation (p = 0.02), but this difference disappeared with advancing gestation. CHD cases demonstrated a slightly shallower Sylvian fissure (mean ratio 0.146 vs. 0.153; p = 0.004). Conclusions: Our study shows no differences in cerebral growth, studied in an unselected cohort, with successive cases of isolated CHD. Even in the severest CHD cases, cerebral size is similar in the early third trimester. The cause and meaning of a shallower Sylvian fissure is unclear; possibly, it is a marker for delayed cerebral maturation or it might be an expression of decreasing amount of extracerebral fluid.

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“…Prenatal counseling of CHD is challenging for fetal medicine specialists although the extended knowledge of these diseases together with cardiac surgery advancements are still related to critical survival rates and poor neurodevelopment later in life (23,24).…”

Section: Editorialmentioning

confidence: 99%

Changes in biometry and cerebroplacental hemodynamics in fetuses with congenital heart diseases

Peixoto

Tonni²,

Júnior

2016

J. Thorac. Dis.

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Brain abnormalities and neurodevelopmental delay in congenital heart disease: systematic review and meta-analysis

Abstract: Objectives

Cited by 163 publications

References 69 publications

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

Changes in biometry and cerebroplacental hemodynamics in fetuses with congenital heart diseases

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