Serial prenatal and post-natal brain MRI demonstrates impact of congenital heart disease and cardiac surgery on brain growth and maturity
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KeywordsApparent Diffusion Coefficient Congenital Heart Disease Brain Volume Ventricular Septal Defect Hypoplastic Left Heart Syndrome
Fetuses and infants with congenital heart disease (CHD) have delayed brain maturation and lower brain volumes (BV) compared to normal [1-4]. To understand the impact of CHD and cardiac surgery on brain maturation, we performed serial brain MRI studies in patients with common cyanotic CHD before and after birth.
Post-natal brain MRI were performed without sedation in 24 infants with common CHD before and after the cardiac surgery on a Siemens Avanto 1.5T system (Erlangen) after hospital IRB approval. 18 of 24 subjects also had fetal MRI using previously described technique  and BV and fetal weight were calculated . The normal brain weights were obtained from published autopsy data  and converted to BV . T2 mapping and diffusion weighted imaging were performed to measure T2 and apparent diffusion coefficient (ADC), respectively . The mean T2 and ADC were measured in postnatal brains using 12 regions of interest located bilaterally at frontal and posterior white matter (WM) at inferior basal ganglia level; superior frontal and parietal WM at level of horns of lateral ventricles; and frontal and posterior centrum semiovale level. Cerebral oxygen delivery (CDO2) was also measured . The daily change in BV, T2, and ADC were calculated by dividing the difference in values by days between the scans. The correlation between BV, T2, and ADC was examined using Pearson's Correlation.
Infants with TGA/VSD have the most immature brains among common cyanotic CHD probably related to low CDO2 in utero until surgery. Delayed repair leaves them exposed to adverse brain hemodynamics for a longer time. The reversal of normal decline in T2 and ADC in TGA indicates additional pathological process in these brains predisposing them to WM injury during cardiac surgery.
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