Prevalence and Spectrum of In Utero Structural Brain Abnormalities in Fetuses with Complex Congenital Heart Disease

Brossard‐Racine, Marie; Plessis, Adré J. du; Vézina, Gilbert; Robertson, Richard L.; Bulas, Dorothy; Evangelou, Iordanis E.; Donofrio, Mary T.; Freeman, D W; Limperopoulos, Catherine

doi:10.3174/ajnr.a3903

Cited by 71 publications

(83 citation statements)

References 26 publications

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“…Our group has previously shown that neurodevelopmental impairments and brain injury in CHD has its origins in the fetal period, where impaired brain growth and delayed maturation can be detected by advanced MRI (36–39). Alterations in the fetal circulation caused by CHD have been associated with changes in cerebral blood flow and oxygen delivery to the brain, and in turn may contribute to disrupted fetal brain development and long term neurodevelopmental impairments (38).…”

Section: Discussionmentioning

confidence: 99%

3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

et al. 2015

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Introduction Placental insufficiency remains a common cause of perinatal mortality and neurodevelopmental morbidity. Congenital heart disease (CHD) in the fetus and its relationship to placental function is unknown. This study explores placental health and its relationship to neonatal outcomes by comparing placental volumes in healthy pregnancies and pregnancies complicated by CHD using in vivo three-dimensional MRI studies. Methods In a prospective observational study, pregnant women greater than 18 weeks gestation with normal pregnancies or pregnancies complicated by CHD were recruited and underwent fetal MR imaging. The placenta was manually outlined and the volume was calculated in cm3. Brain volume was also calculated and clinical data were also collected. Relationships, including interactive effects, between placental and fetal growth, including brain growth, were evaluated using longitudinal multiple linear regression analysis. Results 135 women underwent fetal MRI between 18 and 39 weeks gestation (mean 31.6 ± 4.4). Placental volume increased exponentially with gestational age (p=0.041). Placental volume was positively associated with birth weight (p <0.001) and increased more steeply with birth weight in CHD-affected fetuses (p=0.046). Total brain and cerebral volumes were smaller in the CHD group (p<0.001), but brainstem volume (p<0.001) was larger. Placental volumes were not associated with brain volumes. Discussion Impaired placental growth in CHD is associated with gestational age and birth weight at delivery. Abnormalities in placental development may contribute to the significant morbidity in this high-risk population. Assessment of placental volume by MRI allows for in vivo assessments of placental development.

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Section: Discussionmentioning

confidence: 99%

3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

et al. 2015

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“…Previous studies have shown high correlations between head circumference at birth and both brain weight and brain volume, and thus head circumference at birth is considered to be a useful proxy for cerebral size. [44][45][46] A previous MRI study reported an increased prevalence of ventriculomegaly and increased extraaxial spaces in fetuses with CHD, 47 and thus an extrapolation from a difference in head circumference at birth to a difference in cerebral size may underestimate the actual difference. Standardization by gestational age at birth may in some cases induce spurious associations.…”

Section: Downloaded Frommentioning

confidence: 99%

Congenital Heart Defects and Indices of Fetal Cerebral Growth in a Nationwide Cohort of 924 422 Liveborn Infants

et al. 2016

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Background— Neurodevelopmental disorders are the most common and distressful comorbidities associated with congenital heart defects (CHD). Head circumference at birth (HC), a proxy for prenatal cerebral growth, is an established risk factor for neurodevelopmental disorders. Methods and Results— In a nationwide cohort, we included all 924 422 liveborn Danish singletons, 1997 to 2011. CHD was present in 5519. The association between CHD and growth indices was analyzed by multivariable linear regression, adjusted for potential confounders. We report mean differences in gestational age–specific z scores in comparison with the general population. CHD was associated with lower HC z scores, –0.10 (95% confidence interval [CI], –0.13 to –0.08). Several CHD subtypes were associated with smaller HC, eg, hypoplastic left heart syndrome, –0.39 (95% CI, –0.58 to –0.21); common arterial trunk, –0.41 (95% CI, –0.74 to –0.09); and major ventricular septal defects, –0.25 (95% CI, –0.35 to –0.15). Other single-ventricle defects, transposition of the great arteries, tetralogy of Fallot, and anomalous pulmonary venous return, were also associated with smaller HC. Transposition of the great arteries was associated with smaller HC relative to birth weight, –0.26 (95% CI, –0.39 to –0.13). Major ventricular septal defects were associated with larger HC relative to birth weight. The results were consistent under various conditions, eg, when siblings of infants with CHD (n=5311) or infants with other major malformations (n=24 974) were used as the reference. Conclusions— Several subtypes of CHD were associated with smaller HC. The associations with major ventricular septal defects, common arterial trunk, and anomalous pulmonary venous return have not previously been described. Only infants with transposition of the great arteries had smaller HC relative to birth weight.

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“…Using MRI and cranial ultrasound as early as 18 wk gestation, CHD fetuses-including those with HLHS-were consistently shown to have smaller head circumference (30), increased prevalence of brain abnormalities (9), lower total brain volume (31), and white matter (WM) abnormalities (9,30). Growth rates in head circumference; cerebral total, GM, and WM volumes; and brain metabolic biomarkers are slower for CHD fetuses relative to controls.…”

Section: Articles Watson Et Almentioning

confidence: 99%

“…Differences in brain structure of CHD patients have been documented in utero (9). Even prior to initial surgery, which often occurs in the neonatal period, signs of brain injury and abnormal cerebral hemodynamics are apparent both in autopsy and MRI studies (10,11).…”

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confidence: 99%

Reduced cortical volume and thickness and their relationship to medical and operative features in post-Fontan children and adolescents

et al. 2017

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Background:We compared brain cortical and subcortical gray matter volumes and cortical thickness between postFontan patients and healthy controls, and examined brain anatomical associations with operative and medical history characteristics. Methods: Post-Fontan (n = 128 volumes; n = 115 thickness) and control subjects (n = 48 volumes; n = 45 thickness) underwent brain MRI at ages 10-19 y. Subcortical and cortical volumes and cortical thicknesses were measured for intergroup comparison. Associations between brain measures and clinical measures were assessed in the Fontan group. results: Widespread, significant reduction in brain volumes and thicknesses existed in the Fontan group compared to controls, spanning all brain lobes and subcortical gray matter. Fontan subjects treated with vs. without the Norwood procedure had smaller volumes in several terminal clusters, but did not differ in cortical thickness. Older age at first operation and increasing numbers of cardiac catheterizations, operative complications, and catheterization complications were associated with lower regional volumes and thicknesses. Increasing numbers of operative complications and cardiac catheterizations were associated with smaller regional volumes in the Norwood group. conclusion: The post-Fontan adolescent brain differs from the normal control brain. Some of these differences are associated with potentially modifiable clinical variables, suggesting that interventions might improve long-term neurocognitive outcome.c ongenital heart disease (CHD) is the most common congenital anomaly, with single ventricle (SV) defects occurring in nearly 10% of patients with CHD (1). Patients with SV, particularly hypoplastic left heart syndrome (HLHS), have higher mortality and morbidity than those with other types of CHD, but their survival has steadily increased for several decades (2). The Fontan procedure, as well as staged palliation

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Prevalence and Spectrum of In Utero Structural Brain Abnormalities in Fetuses with Complex Congenital Heart Disease

Cited by 71 publications

References 26 publications

3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

Congenital Heart Defects and Indices of Fetal Cerebral Growth in a Nationwide Cohort of 924 422 Liveborn Infants

Reduced cortical volume and thickness and their relationship to medical and operative features in post-Fontan children and adolescents

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