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Postnatal cerebral hemodynamics in infants with severe congenital heart disease: a scoping review
Alexandra Angela De Silvestro1,2,3, Christian Johannes Kellenberger3,4, Martina Gosteli5
1Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
Insights
Infants with severe congenital heart disease (CHD) show altered cerebral hemodynamics, impacting brain development. Understanding these changes is crucial for developing better neuroprotection strategies in pediatric cardiology.
Area of Science:
- Pediatric Cardiology
- Neuroimaging
- Neonatal Neurology
Background:
- Severe congenital heart disease (CHD) poses risks for neurodevelopmental impairment in infants.
- Congenital anomalies in cardiovascular anatomy and function can compromise cerebral blood supply.
- Altered cerebral hemodynamics are a key concern in infants with severe CHD.
Purpose of the Study:
- To conduct a scoping review summarizing current knowledge on cerebral hemodynamics in infants with severe CHD.
- To identify neuroimaging methods used to assess cerebral hemodynamics in this population.
- To explore findings related to preoperative hemodynamics, interventions, and associations with brain morphology and neurodevelopment.
Main Methods:
- A comprehensive scoping review of five databases was performed.
- Searched for articles published between January 1990 and February 2022.
- Included studies assessing cerebral hemodynamics using neuroimaging in infants with severe CHD within the first year of life.
Main Results:
- 26 out of 1488 identified publications met the inclusion criteria.
- Doppler ultrasound and magnetic resonance imaging were the primary neuroimaging techniques used.
- Cerebral perfusion was most significantly affected in infants with single ventricle and other cyanotic CHD.
Conclusions:
- Neuroimaging provides valuable insights into cerebral hemodynamics in infants with severe CHD.
- Research is limited by small, heterogeneous cohorts and a lack of longitudinal studies.
- Further research is essential to optimize neuroprotection strategies by understanding altered cerebral perfusion in CHD.
Abstract:
Patients with severe congenital heart disease (CHD) are at risk for impaired neurodevelopment. Cerebral blood supply may be diminished by congenital anomalies of cardiovascular anatomy and myocardial function. The aim of this scoping review was to summarize the current knowledge on cerebral hemodynamics in infants with severe CHD. A scoping review was performed. Five databases were searched for articles published from 01/1990 to 02/2022 containing information on cerebral hemodynamics assessed by neuroimaging methods in patients with severe CHD within their first year of life. A total of 1488 publications were identified, of which 26 were included. Half of the studies used Doppler ultrasound, and half used magnetic resonance imaging techniques. Studies focused on preoperative findings of cerebral hemodynamics, effects of surgical and conservative interventions, as well as on associations between cerebral hemodynamics and brain morphology or neurodevelopment. Cerebral perfusion was most severely affected in patients with single ventricle and other cyanotic disease. Neuroimaging methods provide a large variety of information on cerebral hemodynamics. Nevertheless, small and heterogeneous cohorts complicate this field of research. Further studies are needed to improve our understanding of the link between CHD and altered cerebral hemodynamics to optimize neuroprotection strategies. IMPACT: Postnatal cerebral hemodynamics are altered in infants with congenital heart disease (CHD) as compared to healthy controls, especially in most severe types such as single ventricle or other cyanotic CHD. Associations of these alterations with brain volume and maturation reveal their clinical relevance. Research in this area is limited due to the rarity and heterogeneity of diagnoses. Furthermore, longitudinal studies have rarely been conducted. Further effort is needed to better understand the deviation from physiological cerebral perfusion and its consequences in patients with CHD to optimize neuroprotection strategies.
