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Abnormal interhemispheric connectivity in neonates with D-transposition of the great arteries undergoing
1Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland. malek.makki@kispi.uzh.ch
Insights
Infants with congenital heart disease (CHD) show abnormal development in the genu of the corpus callosum (CC) before and after heart surgery. These microstructural changes may indicate a higher risk for neurodevelopmental issues.
Area of Science:
- Neuroscience
- Pediatric Cardiology
- Medical Imaging
Background:
- Neonates with severe congenital heart disease (CHD) often require cardiopulmonary bypass (CPB) early in life.
- White matter injury can occur pre-operatively, potentially impacting long-term neurodevelopmental and psychosocial outcomes.
- The corpus callosum (CC) is crucial for interhemispheric communication and is vulnerable to injury.
Purpose of the Study:
- To assess the microstructural development of the CC in infants with CHD before and after CPB.
- To investigate changes in the CC in infants undergoing surgery for transposition of the great arteries (d-TGA).
Main Methods:
- Diffusion tensor imaging (DTI) was used to analyze the CC microstructure.
- Quantified diffusion parameters including parallel (E1) and perpendicular (E23) diffusions, apparent diffusion coefficient (ADC), and fractional anisotropy (FA).
- Compared DTI indices in the genu and splenium of the CC between infants with CHD and age-matched healthy controls (HC) before and after surgery.
Main Results:
- Infants with CHD exhibited higher E23, higher ADC, and lower FA in the genu of the CC compared to HC, both pre- and post-surgery.
- No significant differences in DTI indices were found between pre- and post-surgery scans within the CHD group.
- These findings suggest persistent microstructural abnormalities in the genu of the CC in infants with CHD.
Conclusions:
- Abnormal microstructural development in the genu of the CC is present in infants with d-TGA before and after CPB.
- Elevated E23, ADC, and reduced FA may reflect altered axonal pruning, myelination, or oligodendrocyte density.
- The genu of the CC appears more vulnerable than the splenium and could serve as a biomarker for identifying infants at risk for adverse neurodevelopmental outcomes.
Background And Purpose:
Neonates with severe CHD require CPB within the first days of life. White matter injury can occur before surgery, and this may impair the long-term neurodevelopmental and psychosocial outcome. The purpose of this study was to assess the microstructural development of the CC in infants with CHD before and after CPB for transposition of the great arteries.
Materials And Methods:
Fifteen patients with CHD and 11 age-matched HC were recruited. We separately quantified the parallel (E1) and perpendicular (E23) diffusions, the ADC, and FA of the genu of the CC and splenium of the CC before and after surgery.
Results:
In presurgical measures of the genu of the CC, higher E23 (P = .018), higher ADC (P = .026), and lower FA (P = .033) values were measured compared with those in HC. In the postsurgery scans, the genu of the CC had higher E23 (P = .013), higher ADC (P = .012), and lower FA (P = .033) values compared with those in HC. There was no significant difference in any DTI indices between the pre- and postsurgical groups.
Conclusions:
We report abnormal microstructural development in the genu of the CC of infants with d-TGA before and after CPB. High E23, high ADC, and low FA values in the genu of the CC may be explained by abnormal axonal pruning, thinner myelin sheaths, smaller axonal diameters, or more oligodendrocytes. It appears that the genu of the CC is more vulnerable than the splenium of the CC in patients with CHD and may serve as a biomarker to identify infants at highest risk for adverse neurodevelopmental outcome.
