From heart to gut: Exploring the gut microbiome in congenital heart disease

Abstract

Congenital heart disease (CHD) is a prevalent birth defect and a significant contributor to childhood mortality. The major characteristics of CHD include cardiovascular malformations and hemodynamical disorders. However, the impact of CHD extends beyond the circulatory system. Evidence has identified dysbiosis of the gut microbiome in patients with CHD. Chronic hypoxia and inflammation associated with CHD affect the gut microbiome, leading to alterations in its number, abundance, and composition. The gut microbiome, aside from providing essential nutrients, engages in direct interactions with the host immune system and indirect interactions via metabolites. The abnormal gut microbiome or its products can translocate into the bloodstream through an impaired gut barrier, leading to an inflammatory state. Metabolites of the gut microbiome, such as short‐chain fatty acids and trimethylamine N‐oxide, also play important roles in the development, treatment, and prognosis of CHD. This review discusses the role of the gut microbiome in immunity, gut barrier, neurodevelopment, and perioperative period in CHD. By fostering a better understanding of the cross‐talk between CHD and the gut microbiome, this review aims to contribute to improve clinical management and outcomes for CHD patients.

Potential Impact of a Pregnant Woman’s Microbiota on the Development of Fetal Heart Defects: A Review of the Literature

“…[41,44] Antibiotic therapy Risks It can disrupt the gut microbiota, potentially contributing to the development of CHD. [2,23] Epithelial bowel barrier dysfunction (EBD) Risks This can lead to dysbiosis, potentially contributing to the development of CHD. [23,25] Autoimmune diseases and metabolic diseases (e.g., diabetes) Variable Impact depends on type of disease; may be associated with CHD risk.…”

“…While interest in interactions between the microbiome and cardiovascular disease continues to grow, congenital heart disease (CHD) remains relatively understudied in this context. These patients are at increased risk of developing gut dysbiosis and intestinal disorders [ 1 ], highlighting the importance of the gut microbiome in patients’ clinical outcomes, including in the context of gut barrier function and inflammation, as demonstrated in previous studies reporting the association of a disturbed gut microbiome with adverse immunological outcomes in neonates with critical CHD [ 2 ]. In addition, cardiac surgery, especially those requiring extracorporeal circulation, can lead to a disturbed gut microbiome and gut barrier dysfunction, which, in turn, can induce systemic inflammatory responses after surgery [ 2 ].…”