Regional alterations in cerebral growth exist preoperatively in infants with congenital heart disease
Open accessAbstract
Objectives Magnetic resonance imaging has been used to define the neurologic abnormalities in infants with congenital heart disease (CHD), including preoperative injury and delayed brain maturation. The present study used qualitative scoring, cerebral biometry, and diffusion imaging to characterize the preoperative brain abnormalities in infants with CHD, including the identification of regions of greater vulnerability.Methods A total of 67 infants with CHD had preoperative magnetic resonance imaging scans available for analysis of brain injury using qualitative scoring and brain development using qualitative scoring, metrics, and diffusion imaging.Results Qualitative abnormalities were common, with 42% of infants having preoperative 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). A smaller brain size in the frontal and parietal lobes correlated with delayed white matter microstructure reflected by diffusion imaging.Conclusions 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. This might reflect a combination of developmental vulnerability and regional differences in cerebral circulation.
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This finding of lower fractional anisotropy in congenital heart disease has been replicated by several other studies over the last decade.
“This finding has been replicated over the last decade by several other studies.[53][54][55]”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [55]
Preoperative brain injury is accompanied by decreased microstructural white matter maturation, and fetal brain abnormalities are associated with increased risk of acquired brain injury after birth.
“Preoperative brain injury is accompanied by decreased microstructural white matter maturation in several studies, 53,55,74 while fetal brain abnormalities are associated with an increased risk of acquired brain injury after birth.85”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [55]
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- Authors
- Ortinau, C., Beca, J., Lambeth, J., Ferdman, B., Alexopoulos, D., Shimony, J. S., Wallendorf, M., Neil, J., & Inder, T.
- Affiliations
- St. Louis Children's Hospital (US)
- Starship Children's Health (NZ)
- Washington University in St. Louis (US)
- Corresponding author
- Ortinau, Cynthia
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2012-06
- Volume
- 143
- Issue
- 6
- Pages
- 1264-1270.e2
- ISSN
- 0022-5223 (ISSN-L)
- PMC
- PMC3322305
- OpenAlex
- W2018182334
- Cited by
- 94
- References
- 25
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 7 · 2023: 2 · 2022: 8 · 2021: 9 · 2020: 8 · 2019: 9 · 2018: 13 · 2017: 8 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 6 · 2012: 1
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Auckland Medical Research Foundation
- Doris Duke Charitable Foundation
- National Heart Foundation of New Zealand
- Green Lane Research and Educational Fund
- Israel National Road Safety Authority (K23 HD053212, P30HD062171, T32 HD043010)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Keywords
- congenital heart disease, infants, brain size, frontal lobe, brainstem, white matter lesions, white matter microstructure, cerebral circulation, neurodevelopmental vulnerability
- MeSH terms
- Brain, Brain Injuries, Child, Preschool, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Longitudinal Studies, Male, New Zealand, Organ Size, Predictive Value of Tests, Prospective Studies, Regression Analysis, Time Factors, Chi-Square Distribution, Treatment Outcome, Diffusion Magnetic Resonance Imaging, Leukoencephalopathies, Preoperative Period
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