Impaired neuroanatomic development in infants with congenital heart disease.
OBJECTIVE
We performed a regional volumetric study of the brain using 3-dimensional magnetic resonance imaging in infants with congenital heart disease to search for variables in anatomic development of the brain that may be associated with functional impairment.


METHODS
Forty infants with congenital heart disease-17 infants with single ventricle physiology, 5 with transposition of great arteries, and 18 with ventricular septal defect-were studied prospectively by 3-dimensional magnetic resonance imaging of the brain several months after heart surgery.


RESULTS
The global volume of gray matter was significantly reduced in the patients with congenital heart disease compared with normal controls (P < .001), whereas no significant difference in the volume of white matter was observed. Further, the decrease in gray matter volume was more apparent in the frontal lobe than in the temporal lobe, especially in infants with single ventricle physiology or transposition of the great arteries. Multivariate analysis revealed that preoperative hypoxia is strongly associated with decreased frontal gray matter volume (P < .01), as well as a diagnosis of hypoplastic left heart syndrome (P < .05). Of note, frontal gray matter volume, which includes the motor area, correlated weakly with psychomotor developmental index scores (P < .01).


CONCLUSIONS
Brain developmental impairment occurs in many infants with congenital heart disease, especially in those who have preoperative hypoxia and critical congenital heart disease. This quantitative volumetric study encourages larger scale and longitudinal follow-up to elucidate the significance of impaired neuroanatomic development on functional outcome.
Watanabe
Kazuhiro
K
Department of Pediatrics, University of Toyama, Toyama, Japan.
Matsui
Mie
M
Matsuzawa
Junko
J
Tanaka
Chiaki
C
Noguchi
Kyo
K
Yoshimura
Naoki
N
Hongo
Kazuhisa
K
Ishiguro
Mayumi
M
Wanatabe
Sayaka
S
Hirono
Keiich
K
Uese
Keiichiro
K
Ichida
Fukiko
F
Origasa
Hideki
H
Nakazawa
Jun
J
Oshima
Yoshihiro
Y
Miyawaki
Toshio
T
Matsuzaki
Tachiyo
T
Yagihara
Toshikatsu
T
Bilker
Warren
W
Gur
Ruben C
RC
D001921:Brain / Q000254:growth & development*; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011446:Prospective Studies