Neurodevelopmental Outcomes Following Congenital Heart Surgery

Ballweg, Jean A.; Wernovsky, Gil; Gaynor, J. William

doi:10.1007/s00246-006-1450-9

Cited by 123 publications

(107 citation statements)

References 80 publications

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“…Our findings extend the knowledge of long-term neurological impairment and mental health functional morbidities in the population with CHD. Although previous studies have reported elevated risks of adverse neurodevelopmental outcomes among individuals with CHD, including increased occurrence of depression, autism, and epilepsy compared with the general population, [6][7][8]19,[32][33][34][35] our study examined an older adult population to determine the later-life consequences of this neurological outcome. Although the underlying pathophysiological mechanisms are not completely understood, the potential etiologic factors appear multifactorial and consistent with previous findings within the neurodevelopmental scientific literature.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Dementia in Adults With Congenital Heart Disease

Bagge¹,

Henderson

Laursen³

et al. 2018

Circulation

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Editorial, see p XXXBACKGROUND: More children with congenital heart disease (CHD) are surviving to adulthood, and CHD is associated with risk factors for dementia. We compared the risk of dementia in CHD adults to that of the general population. METHODS:In this cohort study, we used medical registries and a medical record review covering all Danish hospitals to identify adults with CHD diagnosed between 1963 and 2012. These individuals with CHD were followed from January 1, 1981, 30 years of age, or date of first CHD registration (index date for matched members of the general population cohort) until hospital diagnosis of dementia, death, emigration, or end of study (December 31, 2012). For each individual with CHD, we identified 10 members of the general population utilizing the Danish Civil Registration System matched on sex and birth year. We computed cumulative incidences and hazard ratios (HRs) of dementia, adjusting for sex and birth year. RESULTS:The cumulative incidence of dementia was 4% by 80 years of age in 10 632 adults with CHD (46% male). The overall HR comparing adults with CHD with the general population cohort was 1.6 (95% confidence interval [CI], 1.3−2.0). The HR among individuals with CHD without extracardiac defects was 1.4 (95% CI, 1.1−1.8). Adults with mild-to-moderate CHD had an HR of 1.5 (95% CI, 1.1−2.0), whereas the HR was 2.0 (95% CI, 1.2−3.3) for severe CHD, including univentricular hearts. The HR for early onset dementia (<65 years of age) was 2.6 (95% CI, 1.8−3.8), whereas the late-onset HR was 1.3 (95% CI, 1.0−1.8).CONCLUSIONS: CHD was associated with an increased risk of dementia compared with the general population, in particular for early onset dementia. Further understanding of dementia risk in the population with CHD is a potential target for future investigation.

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Section: Discussionmentioning

confidence: 99%

“…4,5 Neurodevelopmental deficits among infants and children with CHD are well described. [6][7][8] However, research on long-term neurological outcomes in adults with CHD is more limited. Dementia is among the most important late-life neurological diseases in the general population.…”

mentioning

confidence: 99%

Risk of Dementia in Adults With Congenital Heart Disease

Bagge¹,

Henderson

Laursen³

et al. 2018

Circulation

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“…Ballweg et al (19) have shown that fetuses with CHD exhibits poor neurologic development primary caused by cardiac surgical interventions. However, there is evidence that that brain injuries in CHD patients may be detected at birth and may be caused by chronic cerebral hypoxia due to direct delivery of deoxygenated blood or by intracardiac mixing of oxygenated and deoxygenated blood during the fetal period (20).…”

Section: Editorialmentioning

confidence: 99%

Changes in biometry and cerebroplacental hemodynamics in fetuses with congenital heart diseases

Peixoto

Tonni²,

Júnior

2016

J. Thorac. Dis.

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“…Numerous studies have shown that cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) are responsible for long-term sequelae such as neurological, developmental, motor and behavioral deficits [1][2][3]. The high occurrence of motor abnormalities is a major concern because these can affect between 20% and 60% of patients [2,3].…”

Section: Introductionmentioning

confidence: 99%

Granulocyte-colony stimulating factor suppresses early inflammatory response of striatum in a cardiopulmonary bypass-circulatory arrest model of ischemic brain injury in newborn piglets

Pastuszko¹,

Schears²,

Kubin³

et al. 2013

WJCD

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We investigated the effect of Granulocyte-Colony Stimulating Factor (G-CSF) on expression of pro-and anti-inflammatory proteins in the striatum of newborn piglet brain following cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Piglets were placed on CPB, cooled to 18˚C, subjected to 30 min of DHCA and 1 h of low-flow (20 ml/kg/min), rewarmed to 37˚C, separated from CPB circuit and monitored for 2 h. Striatum was then isolated for protein analysis. The levels of proteins are presented relative to the mean in the control group (mean ± SEM, n = 6). DHCA increased the levels of pro-inflammatory proteins: IL-1alpha (158%  23%, P = 0.05), IL-6 (152%  16%, P = 0.03), TNF-alpha (144%  2%, P = 0.003), MIP-3 alpha (148%  12.6%, P = 0.03), NAP-3 (216%  16%, P = 0.05), GRO (165%  19%, P = 0.03) and BLC (140.4  15%, P = 0.05). Compared to DHCA, the G-CSF-treated group had significantly decreased levels of IL-6 (110.8%  11% vs. 152%  16%, P = 0.05), TNF-alpha (120.6%  5.4% vs. 144%  2%, P = 0.001), MIP-3 alpha (148%  12.6% vs. 104.8%  13%, P = 0.02) and NAP-2 (216%  16% vs. 122%  23%, P = 0.002). The levels of anti-inflammatory proteins did not change in DHCA group compared to control, except for VEGF which decreased to 37.5%  9%, P = 0.003. The levels of all protective proteins in the G-CSF group increased versus the DHCA group, but the increases did not attain a P value of 0.05. Conclusions: In an immature brain subjected to circulatory arrest, the early inflammatory response in the striatum is diminished by pretreatment with G-CSF.

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Neurodevelopmental Outcomes Following Congenital Heart Surgery

Cited by 123 publications

References 80 publications

Risk of Dementia in Adults With Congenital Heart Disease

Risk of Dementia in Adults With Congenital Heart Disease

Changes in biometry and cerebroplacental hemodynamics in fetuses with congenital heart diseases

Granulocyte-colony stimulating factor suppresses early inflammatory response of striatum in a cardiopulmonary bypass-circulatory arrest model of ischemic brain injury in newborn piglets

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