Regional alterations in cerebral growth exist preoperatively in infants with congenital heart disease

Abstract

Objective Magnetic Resonance Imaging (MRI) has defined neurologic abnormalities in infants with congenital heart disease (CHD) including pre-operative injury and delayed brain maturation. This study utilized qualitative scoring, cerebral biometry, and diffusion imaging to characterize pre-operative brain abnormalities in infants with CHD, including the identification of regions of greater vulnerability. Methods Sixty-seven infants with CHD had pre-operative MRI with analysis for brain injury by qualitative scoring and brain development by qualitative scoring, metrics and diffusion imaging. Results Qualitative abnormalities were common, with 42% of infants having pre-operative focal white matter lesions. Infants with CHD had smaller brain measures in the frontal lobe, parietal lobe, cerebellum and brainstem (p<.001); with the frontal lobe and brainstem displaying the greatest alterations (p<.001). Smaller brain size in the frontal and parietal lobes correlated with delayed white matter microstructure reflected by diffusion imaging. Conclusion Infants with CHD commonly display brain injury and delayed brain development. Regional alterations in brain size are present, with the frontal lobe and brainstem demonstrating the greatest alterations, which may reflect a combination of developmental vulnerability and regional differences in cerebral circulation.

Fetal MRI detects early alterations of brain development in Tetralogy of Fallot

“…Children born with congenital heart disease (CHD) frequently show structural and metabolic brain alterations [1][2][3][4][5] that are associated with neurobehavioral impairment 3,6-15 during later life.…”

Brain injury and development in newborns with critical congenital heart disease

“…21 WMI and preoperative delayed brain maturity were not related in a previous study using diffusion imaging and simplified brain metrics. 25 However, diffusion imaging in this study was limited to a subset of that cohort (n 5 19), and simplified brain metrics may not be especially sensitive to the mild degree of WMI observed. Taken together, the accumulated data suggest that focal lesions (i.e., stroke and WMI) in the rapidly developing newborn brain have longer-term impacts not limited to the immediate vicinity of the original lesion evident on MRI.…”

“…24 Brain immaturity has not been consistently identified as a risk factor for acquired brain injury before or after surgery. 14,25 In a prospective cohort of term newborns with CHD studied preoperatively and postoperatively with MRI to characterize brain injury severity (BIS) as well as microstructural and metabolic brain integrity, we hypothesize that 1) impaired preoperative brain development would be associated with increasing BIS preoperatively and postoperatively, and 2) preoperative BIS would predict less mature brain microstructure and metabolism postoperatively. Francisco Benioff Children's Hospital (UCSF) or British Columbia Children's Hospital, University of British Columbia (UBC) in a dual-center prospective cohort study.…”

“…14,25 Brain immaturity, as reflected in the Total Maturation Index, was previously associated with the risk of preoperative and postoperative brain injury. In our current study, we observed a relationship between preoperative brain immaturity and preoperative brain injury but not postoperative brain injury.…”

Neurodevelopmental Outcomes After Cardiac Surgery in Infancy

“…Magnetic resonance imaging (MRI) studies in CHD fetuses show smaller total brain volumes (adjusted for gestational age and weight) and abnormal brain metabolism, as well as delayed cortical development and folding. [27][28][29][30][31] At birth, brain maturation in neonates with HLHS or TGA is delayed by ∼1 month compared with a normative sample. 29 Postnatal MRI studies have shown All characteristics from Table 1 except preoperative mechanical ventilation were considered for inclusion in the models.…”