Congenital heart disease and brain development

Department of Pediatrics, University of California, San Francisco, California, USA.
Annals of the New York Academy of Sciences (Impact Factor: 4.38). 01/2010; 1184(1):68-86. DOI: 10.1111/j.1749-6632.2009.05116.x
Source: PubMed


Brain and heart development occur simultaneously in the human fetus. Given the depth and complexity of these shared morphogenetic programs, it is perhaps not surprising that disruption of organogenesis in one organ will impact the development of the other. Newborns with congenital heart disease show a high frequency of acquired focal brain injury on sensitive magnetic resonance imaging studies in the perioperative period. The surprisingly high incidence of white matter injury in these term newborns suggests a unique vulnerability and may be related to a delay in brain development. These abnormalities in brain development identified with MRI in newborns with congenital heart disease might reflect abnormalities in cerebral blood flow while in utero. A complete understanding of the mechanisms of white matter injury in the term newborn with congenital heart disease will require further investigation of the timing, extent, and causes of delayed fetal brain development in the presence of congenital heart disease.

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    • "Our results indicated that the UA PI and the MCA PI represent risk factors for fetal VSDs. This finding is consistent with those of other population-based studies [20,22,33]. "
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    ABSTRACT: The purpose of this study was to evaluate the efficacy of prenatal ultrasonography and Doppler sonography in detecting isolated ventricular septal defects (VSDs) in a late-second-trimester population. Fetal echocardiography, Doppler ultrasound, and biometry were used to evaluate 2,661 singleton fetuses (1,381 male fetuses and 1,280 female fetuses) between 1 August 2006 and 31 May 2010. The efficacy of each fetal biometry, Doppler ultrasound, and nasal bone length (NBL) measurement was evaluated in all of the fetuses. A standard fetal echocardiographic evaluation, including two-dimensional gray-scale imaging and color and Doppler color flow mapping, was performed on all fetuses. We detected isolated VSDs in 124 of the 2,661 singleton fetuses between 19 and 24 weeks of gestation. The prevalence of isolated VSDs in the study population was 4.66%. A multiple logistic regression analysis indicated that short fetal NBL (odds ratio = 0.691, 95% confidence interval: 0.551 to 0.868) and the pulsatility index (PI) of the umbilical artery (odds ratio = 8.095, 95% confidence interval: 4.309 to 15.207) and of the middle cerebral artery (odds ratio = 0.254, 95% confidence interval: 0.120 to 0.538) are significantly associated with isolated VSDs. Late-second-trimester fetal NBL, umbilical artery PI, and middle cerebral artery PI are useful parameters for detecting isolated VSDs, and can be used to estimate the a priori risk of VSDs in women at high risk and at low risk of isolated VSDs.
    01/2014; 19(1):3. DOI:10.1186/2047-783X-19-3
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    • "Hypoxia-ischemia (H-I) is a major cause of perinatal cerebral white matter injury (WMI) [1], the most common lesion in children with cerebral palsy (CP) [2]. Survivors of premature birth [3] and infants with congenital heart disease [4] have an increased risk for WMI and its associated non-progressive motor deficits and cognitive/learning disabilities. Although advances in the care of critically ill newborns have coincided with a reduction in the severity of WMI as defined by neuropathology [5] and MRI studies [6], considerable variability in the spectrum of WMI persists. "
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    ABSTRACT: Although the spectrum of perinatal white matter injury (WMI) in preterm infants is shifting from cystic encephalomalacia to milder forms of WMI, the factors that contribute to this changing spectrum are unclear. We hypothesized that the variability in WMI quantified by immunohistochemical markers of inflammation could be correlated with the severity of impaired blood oxygen, glucose and lactate. We employed a preterm fetal sheep model of in utero moderate hypoxemia and global severe but not complete cerebral ischemia that reproduces the spectrum of human WMI. Since there is small but measurable residual brain blood flow during occlusion, we sought to determine if the metabolic state of the residual arterial blood was associated with severity of WMI. Near the conclusion of hypoxia-ischemia, we recorded cephalic arterial blood pressure, blood oxygen, glucose and lactate levels. To define the spectrum of WMI, an ordinal WMI rating scale was compared against an unbiased quantitative image analysis protocol that provided continuous histo-pathological outcome measures for astrogliosis and microgliosis derived from the entire white matter. A spectrum of WMI was observed that ranged from diffuse non-necrotic lesions to more severe injury that comprised discrete foci of microscopic or macroscopic necrosis. Residual arterial pressure, oxygen content and blood glucose displayed a significant inverse association with WMI and lactate concentrations were directly related. Elevated glucose levels were the most significantly associated with less severe WMI. Our results suggest that under conditions of hypoxemia and severe cephalic hypotension, WMI severity measured using unbiased immunohistochemical measurements correlated with several physiologic parameters, including glucose, which may be a useful marker of fetal response to hypoxia or provide protection against energy failure and more severe WMI.
    PLoS ONE 12/2013; 8(12):e82940. DOI:10.1371/journal.pone.0082940 · 3.23 Impact Factor
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    • "The condition involves the death of small areas of the brain tissue around fluidfilled areas called ventricles. Research has shown a high incidence of PVL both before and after cardiac surgery in neonates [5], [6]. Recently, there has been a growing interest in clinical research to aim to understand the progression and pathology of PVL, to develop protocols for the prevention of PVL development and to examine the trends in outcomes of individuals with PVL [7]. "
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    ABSTRACT: This paper is concerned with predicting the occurrence of Periventricular Leukomalacia (PVL) using vital data which are collected over a period of twelve hours after neonatal cardiac surgery. The vital data contain heart rate (HR), mean arterial pressure (MAP), right atrium pressure (RAP), and oxygen saturation (SpO2). Various features are extracted from the data and are then ranked so that an optimal subset of features that have the highest discriminative capabilities can be selected. A decision tree (DT) is then developed for the vital data in order to identify the most important vital measurements. The DT result shows that high amplitude 20 minutes variations and low sample entropy in the data is an important factor for prediction of PVL. Low sample entropy represents lack of variability in hemodynamic measurement, and constant blood pressure with small fluctuations is an important indicator of PVL occurrence. Finally, using the different time frames of the collected data, we show that the first six hours of data contain sufficient information for PVL occurrence prediction.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 07/2013; 2013:7080-7083. DOI:10.1109/EMBC.2013.6611189
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