Fetal brain growth and risk of postnatal white matter injury in critical congenital heart disease.

Published on Sep 1, 2021in The Journal of Thoracic and Cardiovascular Surgery5.209
· DOI :10.1016/J.JTCVS.2020.09.096
Shabnam Peyvandi13
Estimated H-index: 13
(UCSF: University of California, San Francisco),
Jessie Mei Lim5
Estimated H-index: 5
(U of T: University of Toronto)
+ 6 AuthorsMike Seed25
Estimated H-index: 25
(U of T: University of Toronto)
Sources
Abstract
Abstract Objective To test the hypothesis that delayed brain development in fetuses with d-transposition of the great arteries or hypoplastic left heart syndrome heightens their postnatal susceptibility to acquired white matter injury. Methods This is a cohort study across 3 sites. Subjects underwent fetal (third trimester) and neonatal preoperative magnetic resonance imaging of the brain to measure total brain volume as a measure of brain maturity and the presence of acquired white matter injury after birth. White matter injury was categorized as no-mild or moderate-severe based on validated grading criteria. Comparisons were made between the injury groups. Results A total of 63 subjects were enrolled (d-transposition of the great arteries: 37; hypoplastic left heart syndrome: 26). White matter injury was present in 32.4% (n = 12) of d-transposition of the great arteries and 34.6% (n = 8) of those with hypoplastic left heart syndrome. Overall total brain volume (taking into account fetal and neonatal scan) was significantly lower in those with postnatal moderate-severe white matter injury compared with no-mild white matter injury after adjusting for age at scan and site in d-transposition of the great arteries (coefficient: 14.8 mL, 95% confidence interval, −28.8 to −0.73, P = .04). The rate of change in total brain volume from fetal to postnatal life did not differ by injury group. In hypoplastic left heart syndrome, no association was noted between overall total brain volume and change in total brain volume with postnatal white matter injury. Conclusions Lower total brain volume beginning in late gestation is associated with increased risk of postnatal moderate-severe white matter injury in d-transposition of the great arteries but not hypoplastic left heart syndrome. Rate of brain growth was not a risk factor for white matter injury. The underlying fetal and perinatal physiology has different implications for postnatal risk of white matter injury.
References27
Newest
Background: Brain injury, impaired brain growth, and long-term neurodevelopmental problems are common in children with transposition of the great arteries. We sought to identify clinical risk facto...
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#2Nadieh Khalili (UU: Utrecht University)H-Index: 5
Last. M J N L BendersH-Index: 15
view all 11 authors...
BACKGROUND AND PURPOSE: Fetuses and neonates with critical congenital heart disease are at risk of delayed brain development and neurodevelopmental impairments. Our aim was to investigate the association between fetal and neonatal brain volumes and neonatal brain injury in a longitudinally scanned cohort with an antenatal diagnosis of critical congenital heart disease and to relate fetal and neonatal brain volumes to postmenstrual age and type of congenital heart disease. MATERIALS AND METHODS: ...
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#1Ting Guo (U of T: University of Toronto)H-Index: 12
#2Vann Chau (U of T: University of Toronto)H-Index: 22
Last. Steven P. Miller (U of T: University of Toronto)H-Index: 79
view all 14 authors...
Abstract Background Neonates with congenital heart disease (CHD) are at high risk of punctate white matter injury (WMI) and impaired brain development. We hypothesized that WMI in CHD neonates occurs in a characteristic distribution that shares topology with preterm WMI and that lower birth gestational age (GA) is associated with larger WMI volume. Objective (1) To quantitatively assess the volume and location of WMI in CHD neonates across three centres. (2) To compare the volume and spatial dis...
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#1Abbas Haider Zaidi (Harvard University)H-Index: 3
#2Jane W. Newburger (Harvard University)H-Index: 128
Last. Caitlin K. Rollins (Harvard University)H-Index: 14
view all 8 authors...
Background In neonates with single ventricle, smaller ascending aorta diameter is associated with cerebral white matter (WM) microstructural abnormalities. We sought to determine whether this assoc...
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#1Shabnam Peyvandi (UCSF: University of California, San Francisco)H-Index: 13
#2Vann Chau (U of T: University of Toronto)H-Index: 22
Last. Patrick S. McQuillenH-Index: 36
view all 10 authors...
Abstract Background Brain injury (BI) is reported in 60% of newborns with critical congenital heart disease as white matter injury (WMI) or stroke. Neurodevelopmental (ND) impairments are reported in these patients. The relationship between neonatal BI and ND outcome has not been established. Objectives This study sought to determine the association between peri-operative BI and ND outcomes in infants with single ventricle physiology (SVP) and d-transposition of the great arteries (d-TGA). Metho...
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Long-term neurological deficits due to immature cortical development are emerging as a major challenge in congenital heart disease (CHD). However, cellular mechanisms underlying dysregulation of perinatal corticogenesis in CHD remain elusive. The subventricular zone (SVZ) represents the largest postnatal niche of neural stem/progenitor cells (NSPCs). We show that the piglet SVZ resembles its human counterpart and displays robust postnatal neurogenesis. We present evidence that SVZ NSPCs migrate ...
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#1Shabnam Peyvandi (UCSF: University of California, San Francisco)H-Index: 13
#2Veronica de Santiago (UCSF: University of California, San Francisco)H-Index: 1
Last. Patrick S. McQuillen (UCSF: University of California, San Francisco)H-Index: 36
view all 10 authors...
Importance The relationship of prenatal diagnosis of critical congenital heart disease (CHD) with brain injury and brain development is unknown. Given limited improvement of CHD outcomes with prenatal diagnosis, the effect of prenatal diagnosis on brain health may reveal additional benefits. Objective To compare the prevalence of preoperative and postoperative brain injury and the trajectory of brain development in neonates with prenatal vs postnatal diagnosis of CHD. Design, Setting, and Partic...
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#4Shi-Joon Yoo (U of T: University of Toronto)H-Index: 50
#10John Kingdom (U of T: University of Toronto)H-Index: 16
Background—Fetal hypoxia has been implicated in the abnormal brain development seen in newborns with congenital heart disease (CHD). New magnetic resonance imaging technology now offers the potential to investigate the relationship between fetal hemodynamics and brain dysmaturation. Methods and Results—We measured fetal brain size, oxygen saturation, and blood flow in the major vessels of the fetal circulation in 30 late-gestation fetuses with CHD and 30 normal controls using phase-contrast magn...
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#1Selma O. Algra (UU: Utrecht University)H-Index: 11
#2Felix Haas (UU: Utrecht University)H-Index: 13
Last. Linda S. de Vries (UU: Utrecht University)H-Index: 64
view all 12 authors...
Objective To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers. Study design From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Col...
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#1Stephen A. Back (OHSU: Oregon Health & Science University)H-Index: 54
#2Steven P. Miller (U of T: University of Toronto)H-Index: 79
With advances in neonatal care, preterm neonates are surviving with an evolving constellation of motor and cognitive disabilities that appear to be related to widespread cellular maturational disturbances that target cerebral gray and white matter. Whereas preterm infants were previously at high risk for destructive brain lesions that resulted in cystic white matter injury and secondary cortical and subcortical gray matter degeneration, contemporary cohorts of preterm survivors commonly display ...
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Cited By5
Newest
PURPOSE OF REVIEW To introduce the reader to the current understanding of the neurocognitive profile of congenital heart disease (CHD) survivors, the risk factors that may influence outcomes, and to the recommendations for cardiac neurodevelopmental care. RECENT FINDINGS A growing body of literature has shown that survivors of CHD are at increased risk for neurodevelopmental impairments. Multiple elements influence each patient's risk, which likely begins in utero and extends to perioperative ma...
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#1Syed Murfad Peer (GW: George Washington University)
#2Yves d'Udekem (GW: George Washington University)H-Index: 49
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