Article

Brain Volume and Metabolism in Fetuses With Congenital Heart Disease Evaluation With Quantitative Magnetic Resonance Imaging and Spectroscopy

Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
Circulation (Impact Factor: 14.95). 12/2009; 121(1):26-33. DOI: 10.1161/CIRCULATIONAHA.109.865568
Source: PubMed

ABSTRACT Adverse neurodevelopmental outcome is an important source of morbidity in children with congenital heart disease (CHD). A significant proportion of newborns with complex CHD have abnormalities of brain size, structure, or function, which suggests that antenatal factors may contribute to childhood neurodevelopmental morbidity.
Brain volume and metabolism were compared prospectively between 55 fetuses with CHD and 50 normal fetuses with the use of 3-dimensinal volumetric magnetic resonance imaging and proton magnetic resonance spectroscopy. Fetal intracranial cavity volume, cerebrospinal fluid volume, and total brain volume were measured by manual segmentation. Proton magnetic resonance spectroscopy was used to measure the cerebral N-acetyl aspartate: choline ratio (NAA:choline) and identify cerebral lactate. Complete fetal echocardiograms were performed. Gestational age at magnetic resonance imaging ranged from 25 1/7 to 37 1/7 weeks (median, 30 weeks). During the third trimester, there were progressive and significant declines in gestational age-adjusted total brain volume and intracranial cavity volume in CHD fetuses relative to controls. NAA:choline increased progressively over the third trimester in normal fetuses, but the rate of rise was significantly slower (P<0.001) in CHD fetuses. On multivariable analysis adjusted for gestational age and weight percentile, cardiac diagnosis and percentage of combined ventricular output through the aortic valve were independently associated with total brain volume. Independent predictors of lower NAA:choline included diagnosis, absence of antegrade aortic arch flow, and evidence of cerebral lactate (P<0.001).
Third-trimester fetuses with some forms of CHD have smaller gestational age- and weight-adjusted total brain volumes than normal fetuses and evidence of impaired neuroaxonal development and metabolism. Hemodynamic factors may play an important role in this abnormal development.

0 Bookmarks
 · 
117 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this article is to describe the epidemiology and factors associated with acute neurologic injury in neonates with congenital heart disease (CHD) undergoing extracorporeal membrane oxygenation (ECMO). It is a retrospective cohort study. Multi-institutional data for purposes of this study were obtained from the extracorporeal life support organization registry Neonates with CHD supported with ECMO during 2005-2010. Of 1,898 neonates with CHD supported with ECMO, 273 (14%) had neurologic injury. Birth weight less than 3 kg (odds ratio [OR]: 1.5; 95% confidence intervals [CI]: 1.1-1.9), pre-ECMO blood pH <= 7.15 (OR: 1.5, 95% CI: 1.1-2.1) need for cardiopulmonary resuscitation before ECMO (OR: 1.7, 95% CI: 1.5-2.0) increased neurologic injury. In-hospital mortality was higher in patients with neurologic injury compared with those without (73% vs. 53%; p < 0.001). Neonates with CHD undergoing ECMO are highly vulnerable to acute neurologic injury regardless of cardiac lesion-specific physiology or the occurrence of cardiac surgery. The incidence of neurologic injuries in this population is higher in sicker patients. Severity of illness should therefore become the main target for improvement. Timely deployment of ECMO may therefore influence the development of ECMO complications.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 09/2014; 61(1). DOI:10.1097/MAT.0000000000000151 · 1.39 Impact Factor
  • Journal of Thoracic and Cardiovascular Surgery 11/2014; 148(5):1790-1. DOI:10.1016/j.jtcvs.2014.09.061 · 3.99 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The luxury of studying the cognitive outcomes of survivors of infant heart surgery only occurs as a consequence of the success of the surgeries. The last two decades of improvement in surgical survival has allowed us to focus our attention beyond survival and cardiac outcomes, to a more holistic view of the child, their academic achievement and prospects for successful independence. Most of what we know about long-term outcomes is from the Boston Circulatory Arrest Study, which began in 1988 and followed the lives of 171 infants with transposition of the great arteries (TGA) randomized to a surgical strategy that either included hypothermic circulatory arrest or did not. The most recent report on 139 adolescent survivors (age 16.1 + 0.5 years) from this study documented some significant psycho-educational challenges that were not so severe as they were prevalent.(1) Briefly, grade retention occurred in 17%, special education in 25% and psychotherapy or counseling in 25%. Most significantly, the study reports the negative finding that surgical strategy failed to identify increased risk for the outcome measures. To quote the report "In many respects, the similarities in the outcomes of the 2 groups have been more striking than the differences." Both groups suffered from poor academic achievement, fine motor function, visual spatial skills, sustained attention and social cognition.
    Circulation 03/2015; DOI:10.1161/CIRCULATIONAHA.115.016024 · 14.95 Impact Factor

Full-text (2 Sources)

Download
24 Downloads
Available from
Jun 10, 2014