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White Matter Volume Predicts Language Development in Congenital Heart Disease
Caitlin K Rollins1, Lisa A Asaro2, Alireza Akhondi-Asl3
1Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA.
Insights
Infants with repaired congenital heart disease (CHD) have reduced brain volumes at one year, particularly in white matter. This white matter volume is linked to language development, suggesting a potential cause for speech impairments after heart surgery.
Area of Science:
- Neuroscience
- Pediatrics
- Cardiology
Background:
- Congenital heart disease (CHD) affects brain development.
- Early surgical repair aims to improve outcomes.
- Long-term neurodevelopmental impacts require further investigation.
Purpose of the Study:
- To assess brain volume at 1 year in infants with biventricular CHD post-repair.
- To determine the association between brain volumes and neurodevelopmental outcomes.
Main Methods:
- Brain MRI and neurodevelopmental testing (Bayley Scales, MacArthur-Bates Inventories) were performed at 1 year in 48 infants with biventricular CHD.
- Volumetric MRI data were analyzed using a probabilistic segmentation algorithm.
- Comparisons were made with 13 healthy control infants.
Main Results:
- Infants with CHD showed significantly reduced total brain (54 mL), cerebral white matter (40 mL), and brainstem (1.2 mL) volumes compared to controls.
- White matter volume positively correlated with language development scores (MacArthur-Bates CDI).
- No significant correlation was found between brain volumes and overall developmental scores (Bayley Scales).
Conclusions:
- Biventricular CHD repaired in infancy is associated with reduced total brain volume, primarily in cerebral white matter, by 1 year of age.
- Cerebral white matter volume is linked to language development, suggesting a potential mechanism for language impairments.
- These findings highlight the importance of monitoring white matter development in infants with CHD.
Objective:
To determine whether brain volume is reduced at 1 year of age and whether these volumes are associated with neurodevelopment in biventricular congenital heart disease (CHD) repaired in infancy.
Study Design:
Infants with biventricular CHD (n = 48) underwent brain magnetic resonance imaging (MRI) and neurodevelopmental testing with the Bayley Scales of Infant Development-II and the MacArthur-Bates Communicative Development Inventories at 1 year of age. A multitemplate based probabilistic segmentation algorithm was applied to volumetric MRI data. We compared volumes with those of 13 healthy control infants of comparable ages. In the group with CHD, we measured Spearman correlations between neurodevelopmental outcomes and the residuals from linear regression of the volumes on corrected chronological age at MRI and sex.
Results:
Compared with controls, infants with CHD had reductions of 54 mL in total brain (P = .009), 40 mL in cerebral white matter (P <.001), and 1.2 mL in brainstem (P = .003) volumes. Within the group with CHD, brain volumes were not correlated with Bayley Scales of Infant Development-II scores but did correlate positively with MacArthur-Bates Communicative Development Inventory language development.
Conclusions:
Infants with biventricular CHD show total brain volume reductions at 1 year of age, driven by differences in cerebral white matter. White matter volume correlates with language development, but not broader developmental indices. These findings suggest that abnormalities in white matter development detected months after corrective heart surgery may contribute to language impairment.
Trial Registration:
ClinicalTrials.gov: NCT00006183.
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