Impact of congenital heart disease on brain development and neurodevelopmental outcome

Abstract

Advances in cardiac surgical techniques and perioperative intensive care have led to improved survival in babies with congenital heart disease (CHD). While it is true that the majority of children with CHD today will survive, many will have impaired neurodevelopmental outcome across a wide spectrum of domains. While continuing to improve short-term morbidity and mortality is an important goal, recent and ongoing research has focused on defining the impact of CHD on brain development, minimizing postnatal brain injury, and improving long-term outcomes. This paper will review the impact that CHD has on the developing brain of the fetus and infant. Neurologic abnormalities detectable prior to surgery will be described. Potential etiologies of these findings will be discussed, including altered fetal intrauterine growth, cerebral blood flow and brain development, associated congenital brain abnormalities, and risk for postnatal brain injury. Finally, reported neurodevelopmental outcomes after surgical repair of CHD will be reviewed.

Figure 1

(a) Normal fetal blood flow. (b) Hypoplastic left heart syndrome. (c) left ventricular outflow obstruction. (d) Transposition of the Great Arteries. (e) tetralogy of fallot. (f) hypoplastic right heart. Red arrows: oxygenated blood; blue arrows: deoxygenated blood.

Figure 2

Cerebral to placental resistance ratio versus gestational age for normal fetuses and fetuses with Congenital Heart Disease (CHD). *P is significant normal versus CHD.