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Regional alterations in cerebral growth exist preoperatively in infants with congenital heart disease
Cynthia Ortinau1, John Beca, Jennifer Lambeth
1Department of Pediatrics, St. Louis Children's Hospital and Washington University, St. Louis, MO 63110, USA. Ortinau_c@kids.wustl.edu
Insights
Infants with congenital heart disease (CHD) often show brain injury and delayed development before surgery. The frontal lobe and brainstem are most affected, indicating developmental vulnerabilities.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Cardiology
Background:
- Congenital heart disease (CHD) is associated with significant neurological risks in infants.
- Magnetic resonance imaging (MRI) is crucial for assessing brain abnormalities in these infants.
Purpose of the Study:
- To characterize preoperative brain abnormalities in infants with CHD using qualitative scoring, cerebral biometry, and diffusion imaging.
- To identify specific brain regions vulnerable to injury and delayed development in infants with CHD.
Main Methods:
- Preoperative MRI scans were analyzed in 67 infants with CHD.
- Methods included qualitative scoring, cerebral biometry, and diffusion imaging to assess brain injury and development.
Main Results:
- 42% of infants with CHD exhibited preoperative focal white matter lesions.
- Infants with CHD showed smaller brain volumes in the frontal lobe, parietal lobe, cerebellum, and brainstem.
- The frontal lobe and brainstem displayed the most significant alterations in size.
Conclusions:
- Infants with CHD frequently present with preoperative brain injury and delayed brain development.
- Regional brain size differences, particularly in the frontal lobe and brainstem, are evident.
- These findings suggest developmental vulnerability and potential issues with cerebral circulation in infants with CHD.
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.
