Impaired neuroanatomic development in infants with congenital heart disease

  • Dr Kazuhiro Watanabe, University of Toyama, Japan
  • Dr Mie Matsui, University of Toyama, Japan
  • Dr Naoki Yoshimura, University of Toyama, Japan
  • Dr Keiich Hirono, University of Toyama, Japan
  • Dr Fukiko Ichida, University of Toyama, Japan
  • Dr Yoshihiro Oshima, Hyogo Children's Hospital, Japan
  • Dr Tachiyo Matsuzaki, National Cardiovascular Center, Japan
  • Dr Toshikatsu Yagihara, National Cardiovascular Center, Japan

    • Objectives: Although most infants with critical congenital heart disease (CHD), especially hypoplastic left heat syndrome (HLHS), have a reduced head circumference, there are no data regarding exact brain volume. We
    hypothesized that infants with critical CHD have impaired anatomic development of the brain, and this is associated with functional impairment.
    Methods: We performed a regional volumetric study of the brain using
    3-dimensional magnetic resonance imaging (3D-MRI) in 40 infants with heterogeneous CHD including 17 infants with single ventricle physiology (SV), 5 with transposition of great arteries (TGA), and 18 with ventricular septal defect (VSD) and performed neurodevelopmental assessment using the Bayley Scales of Infant Development II.
    Results: The global volume of gray matter was significantly reduced in the patients with CHD compared with normal controls (P<0.001), whereas no significant difference in the volume of white matter was observed. Further, the decrease in gray matter volume was more apparent in the frontal lobe than in the temporal lobe, especially in infants with SV physiology or TGA. Multivariate analysis revealed that preoperative hypoxia is strongly associated with decreased frontal gray matter volume (P<0.01), as well as a diagnosis of HLHS (P<0.05). Of note, frontal gray matter volume, which includes the motor area, correlated weakly with psychomotor developmental index scores (P<0.01).
    Conclusions: Brain developmental impairment occurs in many infants with CHD, especially in those who have preoperative hypoxia and critical CHD. This quantitative volumetric study encourages larger scale and longitudinal follow-up to elucidate the significance of impaired neuroanatomic development on functional outcome.