Brain Injury and Neurodevelopmental Outcome in Congenital Heart Disease: A Systematic Review

Mebius, Mirthe J; Kooi, Elisabeth M. W.; Bilardo, C. M.; Bos, Arend F.

doi:10.1542/peds.2016-4055

Cited by 137 publications

(120 citation statements)

References 103 publications

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“…In the prenatal period, brain developmental delay is the most common manifestation. After birth, the condition often manifests as white-matter damage or periventricular leukomalacia [18]. In our studies, we did not find a similar gray and white matter damage in children with non-cyanotic CHD because the oxygen saturation was within the normal range from 98% to 100%.…”

Section: Discussioncontrasting

confidence: 71%

Application of voxel-based morphometric measurement to brain magnetic resonance imaging in children with non-cyanotic congenital heart disease

Jia

Liang

et al. 2019

Preprint

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Background Congenital heart disease（CHD） is a cardiovascular malformation caused by abnormal heart and/or vascular development in the fetus. In children with CHD, abnormalities in the development and function of the nervous system are common. At present, there is a lack of research on the preoperative neurological development and injury of young children with non-cyanotic CHD. The objective of the current study is to determine the changes in white matter, gray matter, and cerebrospinal fluid (CSF) by magnetic resonance imaging (MRI) in children with noncyanotic CHD as compared with healthy controls. MethodsChildren diagnosed with non-cyanotic CHD on ultrasonography (n=54) and healthy control subjects (n=35) aged 1–3 years. Brain MRI was performed prior to surgery for CHD. The SPM v12 software was used to calculate the volumes of the gray matter, white matter, CSF, and the whole brain (sum of the gray-matter, white-matter, and CSF volumes). Volume differences between the two groups were analyzed. Voxelbased morphometry was used to compare specific brain regions with statistically significant atrophy.ResultsCompared with the control group, the study group had significantly reduced whole-brain white-matter volume (P<0.05), but similar whole-brain graymatter, CSF, and whole-brain volumes(P>0.05). As compared with the healthy controls, children with non-cyanotic CHD had mild atrophy in the white matter of the anterior central gyrus, the posterior central gyrus and the pulvinar. ConclusionsChildren with non-cyanotic CHD show decreased white-matter volume before surgery, and this volume reduction is mainly concentrated in the somatosensory and somatic motor nerve regions.

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Section: Discussioncontrasting

confidence: 71%

Application of voxel-based morphometric measurement to brain magnetic resonance imaging in children with non-cyanotic congenital heart disease

Jia

Liang

et al. 2019

Preprint

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“…The detrimental effect of CHD on early brain development can be observed via a faltering trajectory of brain growth in the third trimester of pregnancy [4][5][6][7] , and a higher incidence of acquired brain lesions in newborn infants prior to cardiac surgery 8 . The developmental morphology of the cortex has become of increasing interest in CHD, with an 'immature cortical mantle' first observed in autopsies of infants with hypoplastic left heart syndrome (HLHS) 9 .…”

Section: Introductionmentioning

confidence: 99%

Abnormal microstructural development of the cerebral cortex in neonates with congenital heart disease is associated with impaired cerebral oxygen delivery

Kelly

Christiaens

Batallé

et al. 2018

Preprint

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“…However, in a systematic review Mebius and colleagues reported a low MCA-PI in 86 % and a low CPR in 75 % of analyzed studies on cerebral blood flow in CHD fetuses. In accordance with the "brain sparing" effect in growth restricted fetuses reflecting fetal hypoxia, fetuses with HLHS or CHD that are associated with reduced cerebral oxygen delivery in particular had lower MCA-PI values [34].…”

Section: Discussionmentioning

confidence: 62%

Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus

et al. 2019

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Purpose Children with congenital heart disease (CHD) are known to have impaired neurodevelopment possibly influenced by altered cerebroplacental hemodynamics antenatally. We compared fetomaternal Doppler patterns in different CHD groups with published normative values during gestation. Materials and Methods Retrospective cohort study consisting of 248 CHD fetuses. Subgroups were generated according to the expected ascending aorta oxygen saturation: low portion of high oxygenated umbilical venous (UV) blood (group 1: n = 108), intermediate portion of UV blood due to intracardiac mixing with oxygen poor systemic blood (group 2: n = 103), high (group 3: n = 13) and low portion of UV blood without mixing of blood (group 4: n = 24). Doppler examination included umbilical artery and middle cerebral artery pulsatility index (UA-PI, MCA-PI), cerebroplacental ratio (CPR) and mean uterine artery (mUtA) PI. For mean comparisons at different gestational ages (GA), estimated marginal means from regression models are reported for GA 22 weeks (wks), GA 30 wks and GA 38 wks. Results Z-score transformed values of MCA-PI (zMCA-PI) were significantly lower in group 1 compared to all other subgroups at GA 30 wks (p < 0.05). At 38 wks, group 1 had significantly lower values of zMCA-PI and zCPR compared to groups 2 and 4. Group 1 fetuses showed a significant association between zMCA-PI and zCPR (negative) and GA as well as zmUtA-PI (positive) and GA compared to reference values. Conclusion Our data confirm that CHD fetuses have a higher rate of cerebral redistribution in the third trimester. Changes in Doppler patterns were mainly observed in CHD with a low portion of UV blood in the ascending aorta.

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Brain Injury and Neurodevelopmental Outcome in Congenital Heart Disease: A Systematic Review

Abstract: Prenatal and postnatal preoperative abnormal cerebral findings might play an important role in neurodevelopmental impairment in infants with CHD. Increased awareness of the vulnerability of the young developing brain of an infant with CHD among caregivers is essential.

Cited by 137 publications

References 103 publications

Application of voxel-based morphometric measurement to brain magnetic resonance imaging in children with non-cyanotic congenital heart disease

Application of voxel-based morphometric measurement to brain magnetic resonance imaging in children with non-cyanotic congenital heart disease

Abnormal microstructural development of the cerebral cortex in neonates with congenital heart disease is associated with impaired cerebral oxygen delivery

Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus

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