title: Brain in Congenital Heart Disease Across the Lifespan: The Cumulative Burden of Injury.
abstract: The number of patients surviving with congenital heart disease (CHD) has soared over the last 3 decades. Adults constitute the fastest-growing segment of the CHD population, now outnumbering children. Research to date on the heart-brain intersection in this population has been focused largely on neurodevelopmental outcomes in childhood and adolescence. Mutations in genes that are highly expressed in heart and brain may cause cerebral dysgenesis. Together with altered cerebral perfusion in utero, these factors are associated with abnormalities of brain structure and brain immaturity in a significant portion of neonates with critical CHD even before they undergo cardiac surgery. In infancy and childhood, the brain may be affected by risk factors related to heart disease itself or to its interventional treatments. As children with CHD become adults, they increasingly develop heart failure, atrial fibrillation, hypertension, diabetes mellitus, and coronary disease. These acquired cardiovascular comorbidities can be expected to have effects similar to those in the general population on cerebral blood flow, brain volumes, and dementia. In both children and adults, cardiovascular disease may have adverse effects on achievement, executive function, memory, language, social interactions, and quality of life. Against the backdrop of shifting demographics, risk factors for brain injury in the CHD population are cumulative and synergistic. As neurodevelopmental sequelae in children with CHD evolve to cognitive decline or dementia during adulthood, a growing population of CHD can be expected to require support services. We highlight evidence gaps and future research directions.
authors.affiliation: From Division of Cardiology, McGill University Health Centre and Department of Medicine, McGill University, Montreal, QC, Canada (A.M.); The Department of Paediatrics, Hospital for Sick Children and the University of Toronto, ON, Canada (S.P.M.); Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, IL (B.S.M.); Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); and Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, MA (J.W.N.). ariane.marelli@mcgill.ca.
authors.forename: Ariane
authors.initials: A
authors.lastname: Marelli
authors.affiliation: From Division of Cardiology, McGill University Health Centre and Department of Medicine, McGill University, Montreal, QC, Canada (A.M.); The Department of Paediatrics, Hospital for Sick Children and the University of Toronto, ON, Canada (S.P.M.); Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, IL (B.S.M.); Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); and Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, MA (J.W.N.).
authors.forename: Steven P
authors.initials: SP
authors.lastname: Miller
authors.affiliation: From Division of Cardiology, McGill University Health Centre and Department of Medicine, McGill University, Montreal, QC, Canada (A.M.); The Department of Paediatrics, Hospital for Sick Children and the University of Toronto, ON, Canada (S.P.M.); Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, IL (B.S.M.); Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); and Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, MA (J.W.N.).
authors.forename: Bradley Scott
authors.initials: BS
authors.lastname: Marino
authors.affiliation: From Division of Cardiology, McGill University Health Centre and Department of Medicine, McGill University, Montreal, QC, Canada (A.M.); The Department of Paediatrics, Hospital for Sick Children and the University of Toronto, ON, Canada (S.P.M.); Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, IL (B.S.M.); Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); and Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, MA (J.W.N.).
authors.forename: Angela L
authors.initials: AL
authors.lastname: Jefferson
authors.affiliation: From Division of Cardiology, McGill University Health Centre and Department of Medicine, McGill University, Montreal, QC, Canada (A.M.); The Department of Paediatrics, Hospital for Sick Children and the University of Toronto, ON, Canada (S.P.M.); Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, IL (B.S.M.); Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); and Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, MA (J.W.N.).
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D001921:Brain / Q000254:growth & development* / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002657:Child Development / Q000502:physiology; D017281:Cost of Illness; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008136:Longevity / Q000502:physiology*; D012307:Risk Factors
keywords: congenital abnormalities; heart diseases