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Sengupta A, Gauvreau K, Sadhwani A, Butler SC, Newburger JW, Del Nido PJ, Nathan M. Impact of Residual Lesion Severity on Neurodevelopmental Outcomes Following Congenital Heart Surgery in Infancy and Childhood. Pediatr Cardiol 2024; 45:1676-1691. [PMID: 37543999 DOI: 10.1007/s00246-023-03248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
Children with congenital heart disease are at increased risk of neurodevelopmental delay throughout their lifespan. This risk is exacerbated following congenital heart surgery (CHS) in infancy. However, there are few modifiable risk factors for postoperative neurodevelopmental delay. In this study, we assessed the Residual Lesion Score (RLS), a quality assessment metric that evaluates residual lesion severity following CHS, as a predictor of neurodevelopmental delay. This was a single-center, retrospective review of patients who underwent CHS from 01/2011 to 03/2021 and post-discharge neurodevelopmental evaluation from 12 to 42 months of age using the Bayley Scales of Infant Development, 3rd Edition (BSID-III). RLS was assigned per published criteria: RLS 1, no residua; RLS 2, minor residua; and RLS 3, major residua or pre-discharge reintervention. Associations between RLS and BSID-III scores, as well as trends in neurodevelopmental outcomes over time, were evaluated. Of 517 patients with median age at neurodevelopmental testing of 20.0 (IQR 18.0-22.7) months, 304 (58.8%), 146 (28.2%), and 67 (13.0%) were RLS 1, 2, and 3, respectively. RLS 3 patients had significantly lower scaled scores in the cognitive, receptive, and expressive communication, and fine and gross motor domains, compared with RLS 1 patients. Multivariable models accounted for 21.5%-31.5% of the variation in the scaled scores, with RLS explaining 1.4-7.3% of the variation. In a subgroup analysis, RLS 3 patients demonstrated relatively fewer gains in cognitive, expressive communication, and gross motor scores over time (all p < 0.05). In conclusion, RLS 3 patients are at increased risk for neurodevelopmental delay, warranting closer follow-up and greater developmental support for cognitive, language, and motor skills soon after surgery.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Kimberlee Gauvreau
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Anjali Sadhwani
- Department of Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Samantha C Butler
- Department of Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
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Lee FT, Sun L, Szabo A, Milligan N, Saini A, Chetan D, Hunt JL, Macgowan CK, Freud L, Jaeggi E, Van Mieghem T, Kingdom J, Miller SP, Seed M. Safety and feasibility pilot study of continuous low-dose maternal supplemental oxygen in fetal single ventricle heart disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:493-503. [PMID: 38629477 DOI: 10.1002/uog.27657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Fetuses with single ventricle physiology (SVP) exhibit reductions in fetal cerebral oxygenation, with associated delays in fetal brain growth and neurodevelopmental outcomes. Maternal supplemental oxygen (MSO) has been proposed to improve fetal brain growth, but current evidence on dosing, candidacy and outcomes is limited. In this pilot study, we evaluated the safety and feasibility of continuous low-dose MSO in the setting of SVP. METHODS This single-center, open-label, pilot phase-1 safety and feasibility clinical trial included 25 pregnant individuals with a diagnosis of fetal SVP. Participants self-administered continuous MSO using medical-grade oxygen concentrators for up to 24 h per day from the second half of gestation until delivery. The primary aim was the evaluation of the safety profile and feasibility of MSO. A secondary preliminary analysis was performed to assess the impact of MSO on the fetal circulation using echocardiography and late-gestation cardiovascular magnetic resonance imaging. Early outcomes were assessed, including perinatal growth and preoperative brain injury, and neurodevelopmental outcomes were assessed at 18 months using the Bayley Scales of Infant and Toddler Development 3rd edition, and compared with those of a contemporary fetal SVP cohort (n = 217) that received the normal standard of care (SOC). RESULTS Among the 25 participants, the median maternal age at conception was 35 years, and fetal SVP diagnoses included 16 with right ventricle dominant, eight with left ventricle dominant and one with indeterminate ventricular morphology. Participants started the trial at approximately 29 + 2 weeks' gestation and self-administered MSO for a median of 16.1 h per day for 63 days, accumulating a median of 1029 h of oxygen intake from enrolment until delivery. The only treatment-associated adverse events were nasal complications that were resolved typically by attaching a humidifier unit to the oxygen concentrator. No premature closure of the ductus arteriosus or unexpected fetal demise was observed. In the secondary analysis, MSO was not associated with any changes in fetal growth, middle cerebral artery pulsatility index, cerebroplacental ratio or head-circumference-to-abdominal-circumference ratio Z-scores over gestation compared with SOC. Although MSO was associated with changes in umbilical artery pulsatility index Z-score over the study period compared with SOC (P = 0.02), this was probably due to initial baseline differences in placental resistance. At late-gestation cardiovascular magnetic resonance imaging, MSO was not associated with an increase in fetal cerebral oxygen delivery. Similarly, no differences were observed in neonatal outcomes, including preoperative brain weight Z-score and brain injury, mortality by 18 months of age and neurodevelopmental outcomes at 18 months of age. CONCLUSIONS This pilot phase-1 clinical trial indicates that low-dose MSO therapy is safe and well tolerated in pregnancies diagnosed with fetal SVP. However, our protocol was not associated with an increase in fetal cerebral oxygen delivery or improvements in early neurological or neurodevelopmental outcomes. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F-T Lee
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - L Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - A Szabo
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - N Milligan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - A Saini
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - D Chetan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - C K Macgowan
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
- Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Freud
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - E Jaeggi
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - T Van Mieghem
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - J Kingdom
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - S P Miller
- Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, Canada
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Seed
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Wolfe KR, Thomson LM, Niemiec S, Mancuso CA, Khailova L, Frank BS, Davidson JA. Early Circulating Biomarkers of Language Development in Single Ventricle Heart Disease. JAMA Pediatr 2024:2821941. [PMID: 39102258 DOI: 10.1001/jamapediatrics.2024.2507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
This cohort study assesses proteins measured in infancy and neurodevelopmental outcomes in single ventricle heart disease.
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Affiliation(s)
- Kelly R Wolfe
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Lindsay M Thomson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Sierra Niemiec
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora
| | - Christopher A Mancuso
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora
| | - Ludmila Khailova
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Benjamin S Frank
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Jesse A Davidson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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Calixto C, Taymourtash A, Karimi D, Snoussi H, Velasco-Annis C, Jaimes C, Gholipour A. Advances in Fetal Brain Imaging. Magn Reson Imaging Clin N Am 2024; 32:459-478. [PMID: 38944434 PMCID: PMC11216711 DOI: 10.1016/j.mric.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Over the last 20 years, there have been remarkable developments in fetal brain MR imaging analysis methods. This article delves into the specifics of structural imaging, diffusion imaging, functional MR imaging, and spectroscopy, highlighting the latest advancements in motion correction, fetal brain development atlases, and the challenges and innovations. Furthermore, this article explores the clinical applications of these advanced imaging techniques in comprehending and diagnosing fetal brain development and abnormalities.
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Affiliation(s)
- Camilo Calixto
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 401 Park Dr, 7th Floor West, Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Athena Taymourtash
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Spitalgasse 23, Wien 1090, Austria
| | - Davood Karimi
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 401 Park Dr, 7th Floor West, Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Haykel Snoussi
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 401 Park Dr, 7th Floor West, Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Clemente Velasco-Annis
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 401 Park Dr, 7th Floor West, Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Camilo Jaimes
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02215, USA
| | - Ali Gholipour
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, 401 Park Dr, 7th Floor West, Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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Cromb D, Uus A, Van Poppel MP, Steinweg JK, Bonthrone AF, Maggioni A, Cawley P, Egloff A, Kyriakopolous V, Matthew J, Price A, Pushparajah K, Simpson J, Razavi R, DePrez M, Edwards D, Hajnal J, Rutherford M, Lloyd DF, Counsell SJ. Total and Regional Brain Volumes in Fetuses With Congenital Heart Disease. J Magn Reson Imaging 2024; 60:497-509. [PMID: 37846811 PMCID: PMC7616254 DOI: 10.1002/jmri.29078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is common and is associated with impaired early brain development and neurodevelopmental outcomes, yet the exact mechanisms underlying these associations are unclear. PURPOSE To utilize MRI data from a cohort of fetuses with CHD as well as typically developing fetuses to test the hypothesis that expected cerebral substrate delivery is associated with total and regional fetal brain volumes. STUDY TYPE Retrospective case-control study. POPULATION Three hundred eighty fetuses (188 male), comprising 45 healthy controls and 335 with isolated CHD, scanned between 29 and 37 weeks gestation. Fetuses with CHD were assigned into one of four groups based on expected cerebral substrate delivery. FIELD STRENGTH/SEQUENCE T2-weighted single-shot fast-spin-echo sequences and a balanced steady-state free precession gradient echo sequence were obtained on a 1.5 T scanner. ASSESSMENT Images were motion-corrected and reconstructed using an automated slice-to-volume registration reconstruction technique, before undergoing segmentation using an automated pipeline and convolutional neural network that had undergone semi-supervised training. Differences in total, regional brain (cortical gray matter, white matter, deep gray matter, cerebellum, and brainstem) and brain:body volumes were compared between groups. STATISTICAL TESTS ANOVA was used to test for differences in brain volumes between groups, after accounting for sex and gestational age at scan. PFDR-values <0.05 were considered statistically significant. RESULTS Total and regional brain volumes were smaller in fetuses where cerebral substrate delivery is reduced. No significant differences were observed in total or regional brain volumes between control fetuses and fetuses with CHD but normal cerebral substrate delivery (all PFDR > 0.12). Severely reduced cerebral substrate delivery is associated with lower brain:body volume ratios. DATA CONCLUSION Total and regional brain volumes are smaller in fetuses with CHD where there is a reduction in cerebral substrate delivery, but not in those where cerebral substrate delivery is expected to be normal. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Milou P.M. Van Poppel
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Science, King’s College London, London, UK
- Paediatric and Fetal Cardiology Department, Evelina London Children’s Hospital, London, UK
| | - Johannes K. Steinweg
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Science, King’s College London, London, UK
- Paediatric and Fetal Cardiology Department, Evelina London Children’s Hospital, London, UK
| | - Alexandra F. Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Alessandra Maggioni
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Paul Cawley
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Vanessa Kyriakopolous
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Jacqueline Matthew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Kuberan Pushparajah
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Science, King’s College London, London, UK
- Paediatric and Fetal Cardiology Department, Evelina London Children’s Hospital, London, UK
| | - John Simpson
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Science, King’s College London, London, UK
- Paediatric and Fetal Cardiology Department, Evelina London Children’s Hospital, London, UK
| | - Reza Razavi
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Maria DePrez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Jo Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - David F.A. Lloyd
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Science, King’s College London, London, UK
- Paediatric and Fetal Cardiology Department, Evelina London Children’s Hospital, London, UK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
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Xu Y, Li J, Feng X, Qing K, Wu D, Zhao L. Efficient segmentation of fetal brain MRI based on the physical resolution. Med Phys 2024. [PMID: 39008780 DOI: 10.1002/mp.17306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The image resolution of fetal brain magnetic resonance imaging (MRI) is a critical factor in brain development measures, which is mainly determined by the physical resolution configured in the MRI sequence. However, fetal brain MRI are commonly reconstructed to 3D images with a higher apparent resolution, compared to the original physical resolution. PURPOSE This work is to demonstrate that accurate segmentation can be achieved based on the MRI physical resolution, and the high apparent resolution segmentation can be achieved by a simple deep learning module. METHODS This retrospective study included 150 adult and 80 fetal brain MRIs. The adult brain MRIs were acquired at a high physical resolution, which were downsampled to visualize and quantify its impacts on the segmentation accuracy. The physical resolution of fetal images was estimated based on MRI acquisition settings and the images were downsampled accordingly before segmentation and restored using multiple upsampling strategies. Segmentation accuracy of ConvNet models were evaluated on the original and downsampled images. Dice coefficients were calculated, and compared to the original data. RESULTS When the apparent resolution was higher than the physical resolution, the accuracy of fetal brain segmentation had negligible degradation (accuracy reduced by 0.26%, 1.1%, and 1.8% with downsampling factors of 4/3, 2, and 4 in each dimension, without significant differences from the original data). Using a downsampling factor of 4 in each dimension, the proposed method provided 7× smaller and 10× faster models. CONCLUSION Efficient and accurate fetal brain segmentation models can be developed based on the physical resolution of MRI acquisitions.
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Affiliation(s)
- Yunzhi Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Jiaxin Li
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Xue Feng
- Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Kun Qing
- Department of Radiation Oncology, City of Hope National Center, Duarte, California, USA
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Li Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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Yu WH, Chu CH, Chen LW, Lin YC, Koh CL, Huang CC. The developmental phenotype of motor delay in extremely preterm infants following early-life respiratory adversity is influenced by brain dysmaturation in the parietal lobe. J Neurodev Disord 2024; 16:38. [PMID: 39010007 PMCID: PMC11247839 DOI: 10.1186/s11689-024-09546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Research indicates that preterm infants requiring prolonged mechanical ventilation often exhibit suboptimal neurodevelopment at follow-up, coupled with altered brain development as detected by magnetic resonance imaging (MRI) at term-equivalent age (TEA). However, specific regions of brain dysmaturation and the subsequent neurodevelopmental phenotype following early-life adverse respiratory exposures remain unclear. Additionally, it is uncertain whether brain dysmaturation mediates neurodevelopmental outcomes after respiratory adversity. This study aims to investigate the relationship between early-life adverse respiratory exposures, brain dysmaturation at TEA, and the developmental phenotype observed during follow-up in extremely preterm infants. METHODS 89 infants born < 29 weeks' gestation from 2019 to 2021 received MRI examinations at TEA for structural and lobe brain volumes, which were adjusted with sex-and-postmenstrual-age expected volumes for volume residuals. Assisted ventilation patterns in the first 8 postnatal weeks were analyzed using kmlShape analyses. Patterns for motor, cognition, and language development were evaluated from corrected age 6 to 12 months using Bayley Scales of Infant Development, third edition. Mediation effects of brain volumes between early-life respiratory exposures and neurodevelopmental phenotypes were adjusted for sex, gestational age, maternal education, and severe brain injury. RESULTS Two distinct respiratory trajectories with varying severity were identified: improving (n = 35, 39%) and delayed improvement (n = 54, 61%). Compared with the improving group, the delayed improvement group exhibited selectively reduced brain volume residuals in the parietal lobe (mean - 4.9 cm3, 95% confidence interval - 9.4 to - 0.3) at TEA and lower motor composite scores (- 8.7, - 14.2 to - 3.1) at corrected age 12 months. The association between delayed respiratory improvement and inferior motor performance (total effect - 8.7, - 14.8 to - 3.3) was partially mediated through reduced parietal lobe volume (natural indirect effect - 1.8, - 4.9 to - 0.01), suggesting a mediating effect of 20%. CONCLUSIONS Early-life adverse respiratory exposure is specifically linked to the parietal lobe dysmaturation and neurodevelopmental phenotype of motor delay at follow-up. Dysmaturation of the parietal lobe serves as a mediator in the connection between respiratory adversity and compromised motor development. Optimizing respiratory critical care may emerge as a potential avenue to mitigate the consequences of altered brain growth and motor developmental delay in this extremely preterm population.
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Affiliation(s)
- Wen-Hao Yu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Hsiang Chu
- Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 70101, Taiwan.
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei, 23561, Taiwan.
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Vignard V, Baruteau AE, Toutain B, Mercier S, Isidor B, Redon R, Schott JJ, Küry S, Bézieau S, Monsoro-Burq AH, Ebstein F. Exploring the origins of neurodevelopmental proteasomopathies associated with cardiac malformations: are neural crest cells central to certain pathological mechanisms? Front Cell Dev Biol 2024; 12:1370905. [PMID: 39071803 PMCID: PMC11272537 DOI: 10.3389/fcell.2024.1370905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024] Open
Abstract
Neurodevelopmental proteasomopathies constitute a recently defined class of rare Mendelian disorders, arising from genomic alterations in proteasome-related genes. These alterations result in the dysfunction of proteasomes, which are multi-subunit protein complexes essential for maintaining cellular protein homeostasis. The clinical phenotype of these diseases manifests as a syndromic association involving impaired neural development and multisystem abnormalities, notably craniofacial anomalies and malformations of the cardiac outflow tract (OFT). These observations suggest that proteasome loss-of-function variants primarily affect specific embryonic cell types which serve as origins for both craniofacial structures and the conotruncal portion of the heart. In this hypothesis article, we propose that neural crest cells (NCCs), a highly multipotent cell population, which generates craniofacial skeleton, mesenchyme as well as the OFT of the heart, in addition to many other derivatives, would exhibit a distinctive vulnerability to protein homeostasis perturbations. Herein, we introduce the diverse cellular compensatory pathways activated in response to protein homeostasis disruption and explore their potential implications for NCC physiology. Altogether, the paper advocates for investigating proteasome biology within NCCs and their early cranial and cardiac derivatives, offering a rationale for future exploration and laying the initial groundwork for therapeutic considerations.
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Affiliation(s)
- Virginie Vignard
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, Nantes, France
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Nantes, France
| | - Bérénice Toutain
- Nantes Université, CNRS, INSERM, l’institut du thorax, Nantes, France
| | - Sandra Mercier
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
- CHU Nantes, Service de Génétique Médicale, Nantes Université, Nantes, France
| | - Bertrand Isidor
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
- CHU Nantes, Service de Génétique Médicale, Nantes Université, Nantes, France
| | - Richard Redon
- Nantes Université, CNRS, INSERM, l’institut du thorax, Nantes, France
| | | | - Sébastien Küry
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
- CHU Nantes, Service de Génétique Médicale, Nantes Université, Nantes, France
| | - Stéphane Bézieau
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
- CHU Nantes, Service de Génétique Médicale, Nantes Université, Nantes, France
| | - Anne H. Monsoro-Burq
- Faculté des Sciences d'Orsay, CNRS, UMR 3347, INSERM, Université Paris-Saclay, Orsay, France
- Institut Curie, PSL Research University, CNRS, UMR 3347, INSERM, Orsay, France
- Institut Universitaire de France, Paris, France
| | - Frédéric Ebstein
- Nantes Université, CNRS, INSERM, l’institut du thorax, Nantes, France
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9
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Selvanathan T, Mabbott C, Au-Young SH, Seed M, Miller SP, Chau V. Antenatal diagnosis, neonatal brain volumes, and neurodevelopment in transposition of the great arteries. Dev Med Child Neurol 2024; 66:882-891. [PMID: 38204357 DOI: 10.1111/dmcn.15840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024]
Abstract
AIM To examine whether antenatal diagnosis modifies relationships between neonatal brain volumes and 18-month neurodevelopmental outcomes in children with transposition of the great arteries (TGA). METHOD In a retrospective cohort of 139 children with TGA (77 antenatally diagnosed), we obtained total brain volumes (TBVs) on pre- (n = 102) and postoperative (n = 112) magnetic resonance imaging. Eighteen-month neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Generalized estimating equations with interaction terms were used to determine whether antenatal diagnosis modified associations between TBVs and neurodevelopmental outcomes accounting for postmenstrual age at scan, brain injury, and ventricular septal defect. RESULTS Infants with postnatal diagnosis had more preoperative hypotension (35% vs 14%, p = 0.004). The interactions between antenatal diagnosis and TBVs were significantly related to cognitive (p = 0.003) outcomes. Specifically, smaller TBVs were associated with lower cognitive scores in infants diagnosed postnatally; this association was attenuated in those diagnosed antenatally. INTERPRETATION Antenatal diagnosis modifies associations between neonatal brain volume and 18-month cognitive outcome in infants with TGA. These findings suggest that antenatal diagnosis may be neuroprotective, possibly through improved preoperative clinical status. These data highlight the need to improve antenatal diagnosis rates. WHAT THIS PAPER ADDS Antenatal diagnosis of transposition of the great arteries modified relationships between neonatal brain volume and neurodevelopment. Smaller brain volumes related to poorer cognitive scores with postnatal diagnosis only. There was more preoperative hypotension in the postnatal diagnosis group.
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Affiliation(s)
- Thiviya Selvanathan
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, BC Children's Hospital Research Institute and the University of British Columbia, Vancouver, BC, Canada
| | - Connor Mabbott
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Stephanie H Au-Young
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Mike Seed
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Steven P Miller
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, BC Children's Hospital Research Institute and the University of British Columbia, Vancouver, BC, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Vann Chau
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
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10
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Gravholt CH, Andersen NH, Christin-Maitre S, Davis SM, Duijnhouwer A, Gawlik A, Maciel-Guerra AT, Gutmark-Little I, Fleischer K, Hong D, Klein KO, Prakash SK, Shankar RK, Sandberg DE, Sas TCJ, Skakkebæk A, Stochholm K, van der Velden JA, Backeljauw PF. Clinical practice guidelines for the care of girls and women with Turner syndrome. Eur J Endocrinol 2024; 190:G53-G151. [PMID: 38748847 DOI: 10.1093/ejendo/lvae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/19/2024] [Indexed: 06/16/2024]
Abstract
Turner syndrome (TS) affects 50 per 100 000 females. TS affects multiple organs through all stages of life, necessitating multidisciplinary care. This guideline extends previous ones and includes important new advances, within diagnostics and genetics, estrogen treatment, fertility, co-morbidities, and neurocognition and neuropsychology. Exploratory meetings were held in 2021 in Europe and United States culminating with a consensus meeting in Aarhus, Denmark in June 2023. Prior to this, eight groups addressed important areas in TS care: (1) diagnosis and genetics, (2) growth, (3) puberty and estrogen treatment, (4) cardiovascular health, (5) transition, (6) fertility assessment, monitoring, and counselling, (7) health surveillance for comorbidities throughout the lifespan, and (8) neurocognition and its implications for mental health and well-being. Each group produced proposals for the present guidelines, which were meticulously discussed by the entire group. Four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with systematic review of the literature. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with members from the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology, the European Reference Network on Rare Endocrine Conditions, the Society for Endocrinology, and the European Society of Cardiology, Japanese Society for Pediatric Endocrinology, Australia and New Zealand Society for Pediatric Endocrinology and Diabetes, Latin American Society for Pediatric Endocrinology, Arab Society for Pediatric Endocrinology and Diabetes, and the Asia Pacific Pediatric Endocrine Society. Advocacy groups appointed representatives for pre-meeting discussions and the consensus meeting.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Sophie Christin-Maitre
- Endocrine and Reproductive Medicine Unit, Center of Rare Endocrine Diseases of Growth and Development (CMERCD), FIRENDO, Endo ERN Hôpital Saint-Antoine, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, United States
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, CO 80045, United States
| | - Anthonie Duijnhouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen 6500 HB, The Netherlands
| | - Aneta Gawlik
- Departments of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Andrea T Maciel-Guerra
- Area of Medical Genetics, Department of Translational Medicine, School of Medical Sciences, State University of Campinas, 13083-888 São Paulo, Brazil
| | - Iris Gutmark-Little
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, United States
| | - Kathrin Fleischer
- Department of Reproductive Medicine, Nij Geertgen Center for Fertility, Ripseweg 9, 5424 SM Elsendorp, The Netherlands
| | - David Hong
- Division of Interdisciplinary Brain Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
| | - Karen O Klein
- Rady Children's Hospital, University of California, San Diego, CA 92123, United States
| | - Siddharth K Prakash
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Roopa Kanakatti Shankar
- Division of Endocrinology, Children's National Hospital, The George Washington University School of Medicine, Washington, DC 20010, United States
| | - David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-2800, United States
- Division of Pediatric Psychology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-2800, United States
| | - Theo C J Sas
- Department the Pediatric Endocrinology, Sophia Children's Hospital, Rotterdam 3015 CN, The Netherlands
- Department of Pediatrics, Centre for Pediatric and Adult Diabetes Care and Research, Rotterdam 3015 CN, The Netherlands
| | - Anne Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Janielle A van der Velden
- Department of Pediatric Endocrinology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen 6500 HB, The Netherlands
| | - Philippe F Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, United States
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11
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Maleyeff L, Park HJ, Khazal ZSH, Wypij D, Rollins CK, Yun HJ, Bellinger DC, Watson CG, Roberts AE, Newburger JW, Grant PE, Im K, Morton SU. Meta-regression of sulcal patterns, clinical and environmental factors on neurodevelopmental outcomes in participants with multiple CHD types. Cereb Cortex 2024; 34:bhae224. [PMID: 38836834 DOI: 10.1093/cercor/bhae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024] Open
Abstract
Congenital heart disease affects 1% of infants and is associated with impaired neurodevelopment. Right- or left-sided sulcal features correlate with executive function among people with Tetralogy of Fallot or single ventricle congenital heart disease. Studies of multiple congenital heart disease types are needed to understand regional differences. Further, sulcal pattern has not been studied in people with d-transposition of the great arteries. Therefore, we assessed the relationship between sulcal pattern and executive function, general memory, and processing speed in a meta-regression of 247 participants with three congenital heart disease types (114 single ventricle, 92 d-transposition of the great arteries, and 41 Tetralogy of Fallot) and 94 participants without congenital heart disease. Higher right hemisphere sulcal pattern similarity was associated with improved executive function (Pearson r = 0.19, false discovery rate-adjusted P = 0.005), general memory (r = 0.15, false discovery rate P = 0.02), and processing speed (r = 0.17, false discovery rate P = 0.01) scores. These positive associations remained significant in for the d-transposition of the great arteries and Tetralogy of Fallot cohorts only in multivariable linear regression (estimated change β = 0.7, false discovery rate P = 0.004; β = 4.1, false discovery rate P = 0.03; and β = 5.4, false discovery rate P = 0.003, respectively). Duration of deep hypothermic circulatory arrest was also associated with outcomes in the multivariate model and regression tree analysis. This suggests that sulcal pattern may provide an early biomarker for prediction of later neurocognitive challenges among people with congenital heart disease.
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Affiliation(s)
- Lara Maleyeff
- Department of Biostatistics, Epidemiology, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Hannah J Park
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
| | - Zahra S H Khazal
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
| | - David Wypij
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Department of Cardiology, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA, United States
| | - Caitlin K Rollins
- Department of Neurology, Boston Children's Hospital 02115 Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston MA, United States
| | - Hyuk Jin Yun
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital 02115 Boston, MA, United States
- Department of Psychiatry, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston MA, United States
| | - Christopher G Watson
- Department of Neurology, Boston Children's Hospital 02115 Boston, MA, United States
| | - Amy E Roberts
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Department of Cardiology, Boston Children's Hospital, Boston 02115, MA, United States
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Department of Cardiology, Boston Children's Hospital, Boston 02115, MA, United States
| | - P Ellen Grant
- Department of Biostatistics, Epidemiology, and Occupational Health, McGill University, Montreal, QC, Canada
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Radiology, Boston Children's Hospital, Boston 02115, MA, United States
| | - Kiho Im
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
| | - Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston 02115, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston MA, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston 02115, MA, United States
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12
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Guseh S, Tworetzky W. Transforming congenital heart disease management: Advances in fetal cardiac interventions. Prenat Diagn 2024; 44:733-738. [PMID: 38768017 DOI: 10.1002/pd.6592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
This review addresses the transformative advancements in fetal cardiac interventions (FCI) for congenital heart diseases (CHD), with a particular focus on aortic stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an intact ventricular septum, and HLHS with an intact atrial septum (HLHS-IAS). We outline the specific FCI techniques employed, the refined criteria for selecting appropriate fetal and maternal candidates, and the promising yet varied outcomes associated with these procedures. Procedural strategies and clinical decision-making are examined as we take into account the fetal pathophysiology and the benefits and risks of early intervention. We highlight the role of multidisciplinary teams in improving technical success and managing immediate procedural complications, which have led to significant improvements in procedural outcomes. Additionally, the review discusses the long-term outcomes, challenges, and future research directions in FCI, emphasizing the necessity for continuous innovation and collaboration across specialties to advance the management of CHD. The integration of new technologies and research findings holds the promise of further enhancing FCI success rates and patient outcomes.
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Affiliation(s)
- Stephanie Guseh
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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13
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Juergensen S, Liu J, Xu D, Zhao Y, Moon-Grady AJ, Glenn O, McQuillen P, Peyvandi S. Fetal circulatory physiology and brain development in complex congenital heart disease: A multi-modal imaging study. Prenat Diagn 2024; 44:856-864. [PMID: 37817395 PMCID: PMC11004088 DOI: 10.1002/pd.6450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE Fetuses with complex congenital heart disease have altered physiology, contributing to abnormal neurodevelopment. The effects of altered physiology on brain development have not been well studied. We used multi-modal imaging to study fetal circulatory physiology and brain development in hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (TGA). METHODS This prospective, cross-sectional study investigated individuals with fetal congenital heart disease and controls undergoing fetal echocardiography and fetal brain MRI. MRI measured total brain volume and cerebral oxygenation by the MRI quantification method T2*. Indexed cardiac outputs (CCOi) and vascular impedances were calculated by fetal echocardiography. Descriptive statistics assessed MRI and echocardiogram measurement relationships by physiology. RESULTS Sixty-six participants enrolled (control = 20; HLHS = 25; TGA = 21), mean gestational age 33.8 weeks (95% CI: 33.3-34.2). Total brain volume and T2* were significantly lower in fetuses with cardiac disease. CCOi was lower in HLHS, correlating with total brain volume - for every 10% CCOi increase, volume increased 8 mm3 (95% CI: 1.78-14.1; p = 0.012). Echocardiography parameters and cerebral oxygenation showed no correlation. TGA showed no CCOi or aortic output correlation with MRI measures. CONCLUSIONS In HLHS, lower cardiac output is deleterious to brain development. Our findings provide insight into the role of fetal cardiovascular physiology in brain health.
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Affiliation(s)
- Stephan Juergensen
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Yili Zhao
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Anita J Moon-Grady
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Orit Glenn
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Patrick McQuillen
- Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, California, USA
| | - Shabnam Peyvandi
- Department of Pediatrics, Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California, USA
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14
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Lee VK, Ceschin R, Reynolds WT, Meyers B, Wallace J, Landsittel D, Joseph HM, Badaly D, Gaynor JW, Licht D, Greene NH, Brady KM, Hunter JV, Chu ZD, Wilde EA, Easley RB, Andropoulos D, Panigrahy A. Postnatal Brain Trajectories and Maternal Intelligence Predict Childhood Outcomes in Complex CHD. J Clin Med 2024; 13:2922. [PMID: 38792464 PMCID: PMC11121951 DOI: 10.3390/jcm13102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: To determine whether early structural brain trajectories predict early childhood neurodevelopmental deficits in complex CHD patients and to assess relative cumulative risk profiles of clinical, genetic, and demographic risk factors across early development. Study Design: Term neonates with complex CHDs were recruited at Texas Children's Hospital from 2005-2011. Ninety-five participants underwent three structural MRI scans and three neurodevelopmental assessments. Brain region volumes and white matter tract fractional anisotropy and radial diffusivity were used to calculate trajectories: perioperative, postsurgical, and overall. Gross cognitive, language, and visuo-motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development and with the Wechsler Preschool and Primary Scale of Intelligence and Beery-Buktenica Developmental Test of Visual-Motor Integration. Multi-variable models incorporated risk factors. Results: Reduced overall period volumetric trajectories predicted poor language outcomes: brainstem ((β, 95% CI) 0.0977, 0.0382-0.1571; p = 0.0022) and white matter (0.0023, 0.0001-0.0046; p = 0.0397) at 5 years; brainstem (0.0711, 0.0157-0.1265; p = 0.0134) and deep grey matter (0.0085, 0.0011-0.0160; p = 0.0258) at 3 years. Maternal IQ was the strongest contributor to language variance, increasing from 37% at 1 year, 62% at 3 years, and 81% at 5 years. Genetic abnormality's contribution to variance decreased from 41% at 1 year to 25% at 3 years and was insignificant at 5 years. Conclusion: Reduced postnatal subcortical-cerebral white matter trajectories predicted poor early childhood neurodevelopmental outcomes, despite high contribution of maternal IQ. Maternal IQ was cumulative over time, exceeding the influence of known cardiac and genetic factors in complex CHD, underscoring the importance of heritable and parent-based environmental factors.
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Affiliation(s)
- Vincent K. Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
| | - Rafael Ceschin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA
| | - William T. Reynolds
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA
| | - Benjamin Meyers
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
| | - Julia Wallace
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
| | - Douglas Landsittel
- Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY 14260, USA;
| | - Heather M. Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY 10022, USA;
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Daniel Licht
- Perinatal Pediatrics Institute, Children’s National Hospital, Washinton, DC 20010, USA;
| | - Nathaniel H. Greene
- Anesthesiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Ken M. Brady
- Department of Pediatrics and Department of Anesthesiology, Lurie Children’s Hospital, Northwestern University, Chicago, IL 60611, USA;
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA; (J.V.H.); (Z.D.C.); (E.A.W.)
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zili D. Chu
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA; (J.V.H.); (Z.D.C.); (E.A.W.)
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elisabeth A. Wilde
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA; (J.V.H.); (Z.D.C.); (E.A.W.)
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - R. Blaine Easley
- Department of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX 77030, USA; (R.B.E.); (D.A.)
| | - Dean Andropoulos
- Department of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX 77030, USA; (R.B.E.); (D.A.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Ashok Panigrahy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA; (R.C.); (W.T.R.); (B.M.); (J.W.)
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15206, USA
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15
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Wang Z, Liu XY, Yang CX, Zhou HM, Li YJ, Qiu XB, Huang RT, Cen SS, Wang Y, Xu YJ, Qiu HY, Yang YQ. Discovery and functional investigation of BMP4 as a new causative gene for human congenital heart disease. Am J Transl Res 2024; 16:2034-2048. [PMID: 38883374 PMCID: PMC11170606 DOI: 10.62347/dgcd4269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Aggregating evidence highlights the strong genetic basis underpinning congenital heart disease (CHD). Here BMP4 was chosen as a prime candidate gene causative of human CHD predominantly because BMP4 was amply expressed in the embryonic hearts and knockout of Bmp4 in mice led to embryonic demise mainly from multiple cardiovascular developmental malformations. The aim of this retrospective investigation was to discover a novel BMP4 mutation underlying human CHD and explore its functional impact. METHODS A sequencing examination of BMP4 was implemented in 212 index patients suffering from CHD and 236 unrelated non-CHD individuals as well as the family members available from the proband carrying a discovered BMP4 mutation. The impacts of the discovered CHD-causing mutation on the expression of NKX2-5 and TBX20 induced by BMP4 were measured by employing a dual-luciferase analysis system. RESULTS A new heterozygous BMP4 mutation, NM_001202.6:c.318T>G;p.(Tyr106*), was found in a female proband affected with familial CHD. Genetic research of the mutation carrier's relatives unveiled that the truncating mutation was in co-segregation with CHD in the pedigree. The nonsense mutation was absent from 236 unrelated non-CHD control persons. Quantitative biologic measurement revealed that Tyr106*-mutant BMP4 failed to induce the expression of NKX2-5 and TBX20, two genes whose expression is lost in CHD. CONCLUSION The current findings indicate BMP4 as a new gene predisposing to human CHD, allowing for improved prenatal genetic counseling along with personalized treatment of CHD patients.
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Affiliation(s)
- Zhi Wang
- Department of Cardiovascular Medicine, Women and Children's Hospital of Ningbo University Ningbo 315012, Zhejiang, China
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine Shanghai 200065, China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University Shanghai 200240, China
| | - Hui-Min Zhou
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine Shanghai 200065, China
| | - Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine Shanghai 200030, China
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine Shanghai 200030, China
| | - Ri-Tai Huang
- Department of Cardiovascular Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai 200127, China
| | - Shu-Shu Cen
- Health Science Center, Ningbo University Ningbo 315211, Zhejiang, China
| | - Yuan Wang
- Health Science Center, Ningbo University Ningbo 315211, Zhejiang, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University Shanghai 200240, China
| | - Hai-Yan Qiu
- Department of Cardiovascular Medicine, Women and Children's Hospital of Ningbo University Ningbo 315012, Zhejiang, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University Shanghai 200240, China
- Department of Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University Shanghai 200240, China
- Department of Central Laboratory, Shanghai Fifth People's Hospital, Fudan University Shanghai 200240, China
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16
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Zuo JY, Chen HX, Yang Q, He GW. Variants of the promoter of MYH6 gene in congenital isolated and sporadic patent ductus arteriosus: case-control study and cellular functional analyses. Hum Mol Genet 2024; 33:884-893. [PMID: 38340456 DOI: 10.1093/hmg/ddae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/25/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Patent ductus arteriosus (PDA) is a common form of congenital heart disease. The MYH6 gene has important effects on cardiovascular growth and development, but the effect of variants in the MYH6 gene promoter on ductus arteriosus is unknown. DNA was extracted from blood samples of 721 subjects (428 patients with isolated and sporadic PDA and 293 healthy controls) and analyzed by sequencing for MYH6 gene promoter region variants. Cellular function experiments with three cell lines (HEK-293, HL-1, and H9C2 cells) and bioinformatics analyses were performed to verify their effects on gene expression. In the MYH6 gene promoter, 11 variants were identified. Four variants were found only in patients with PDA and 2 of them (g.3434G>C and g.4524C>T) were novel. Electrophoretic mobility shift assay showed that the transcription factors bound by the promoter variants were significantly altered in comparison to the wild-type in all three cell lines. Dual luciferase reporter showed that all the 4 variants reduced the transcriptional activity of the MYH6 gene promoter (P < 0.05). Prediction of transcription factors bound by the variants indicated that these variants alter the transcription factor binding sites. These pathological alterations most likely affect the contraction of the smooth muscle of ductus arteriosus, leading to PDA. This study is the first to focus on variants at the promoter region of the MYH6 gene in PDA patients with cellular function tests. Therefore, this study provides new insights to understand the genetic basis and facilitates further studies on the mechanism of PDA formation.
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Affiliation(s)
- Ji-Yang Zuo
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
| | - Huan-Xin Chen
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
| | - Qin Yang
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
| | - Guo-Wei He
- The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, No. 61, the 3rd Ave, TEDA, Tianjin 300457, China
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17
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Gaynor JW, Moldenhauer JS, Zullo EE, Burnham NB, Gerdes M, Bernbaum JC, D’Agostino JA, Linn RL, Klepczynski B, Randazzo I, Gionet G, Choi GH, Karaj A, Russell WW, Zackai EH, Johnson MP, Gebb JS, Soni S, DeBari SE, Szwast AL, Ahrens-Nicklas RC, Drivas TG, Jacobwitz M, Licht DJ, Vossough A, Nicolson SC, Spray TL, Rychik J, Putt ME. Progesterone for Neurodevelopment in Fetuses With Congenital Heart Defects: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2412291. [PMID: 38805228 PMCID: PMC11134212 DOI: 10.1001/jamanetworkopen.2024.12291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/08/2024] [Indexed: 05/29/2024] Open
Abstract
Importance Neurodevelopmental outcomes for children with congenital heart defects (CHD) have improved minimally over the past 20 years. Objectives To assess the feasibility and tolerability of maternal progesterone therapy as well as the magnitude of the effect on neurodevelopment for fetuses with CHD. Design, Setting, and Participants This double-blinded individually randomized parallel-group clinical trial of vaginal natural progesterone therapy vs placebo in participants carrying fetuses with CHD was conducted between July 2014 and November 2021 at a quaternary care children's hospital. Participants included maternal-fetal dyads where the fetus had CHD identified before 28 weeks' gestational age and was likely to need surgery with cardiopulmonary bypass in the neonatal period. Exclusion criteria included a major genetic or extracardiac anomaly other than 22q11 deletion syndrome and known contraindication to progesterone. Statistical analysis was performed June 2022 to April 2024. Intervention Participants were 1:1 block-randomized to vaginal progesterone or placebo by diagnosis: hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and other CHD diagnoses. Treatment was administered twice daily between 28 and up to 39 weeks' gestational age. Main Outcomes and Measures The primary outcome was the motor score of the Bayley Scales of Infant and Toddler Development-III; secondary outcomes included language and cognitive scales. Exploratory prespecified subgroups included cardiac diagnosis, fetal sex, genetic profile, and maternal fetal environment. Results The 102 enrolled fetuses primarily had HLHS (n = 52 [50.9%]) and TGA (n = 38 [37.3%]), were more frequently male (n = 67 [65.7%]), and without genetic anomalies (n = 61 [59.8%]). The mean motor score differed by 2.5 units (90% CI, -1.9 to 6.9 units; P = .34) for progesterone compared with placebo, a value not statistically different from 0. Exploratory subgroup analyses suggested treatment heterogeneity for the motor score for cardiac diagnosis (P for interaction = .03) and fetal sex (P for interaction = .04), but not genetic profile (P for interaction = .16) or maternal-fetal environment (P for interaction = .70). Conclusions and Relevance In this randomized clinical trial of maternal progesterone therapy, the overall effect was not statistically different from 0. Subgroup analyses suggest heterogeneity of the response to progesterone among CHD diagnosis and fetal sex. Trial Registration ClinicalTrials.gov Identifier: NCT02133573.
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Affiliation(s)
- J. William Gaynor
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Julie S. Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erin E. Zullo
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nancy B. Burnham
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marsha Gerdes
- Department of Psychology, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judy C. Bernbaum
- Department of Pediatrics, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jo Ann D’Agostino
- Department of Pediatrics, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rebecca L. Linn
- Division of Anatomic Pathology, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brenna Klepczynski
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Isabel Randazzo
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gabrielle Gionet
- Department of Biostatistics, Epidemiology, and Informatics, the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Grace H. Choi
- Department of Biostatistics, Epidemiology, and Informatics, the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Antoneta Karaj
- Department of Biostatistics, Epidemiology, and Informatics, the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - William W. Russell
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elaine H. Zackai
- Division of Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mark P. Johnson
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Juliana S. Gebb
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shelly Soni
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Suzanne E. DeBari
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anita L. Szwast
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca C. Ahrens-Nicklas
- Division of Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Theodore G. Drivas
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marin Jacobwitz
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arastoo Vossough
- Division of Radiology, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan C. Nicolson
- Division of Cardiac Anesthesia, Department of Anesthesia and Critical Medicine, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Thomas L. Spray
- Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jack Rychik
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology, and Informatics, the Perelman School of Medicine, University of Pennsylvania, Philadelphia
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18
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Monir ZM, El-Din EMS, Kandeel WA, Sallam SF, Elsheikh E, Abushady MM, Allah FH, Tawfik S, Zeid DA. Evaluation of apparently healthy Egyptian infants and toddlers on the bayley-III scales according to age and sex. Ital J Pediatr 2024; 50:68. [PMID: 38616286 PMCID: PMC11017649 DOI: 10.1186/s13052-024-01635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Child development is shaped throughout the first years of life through the interaction of genetics and the environment. Bayley-III is valuably used to determine early developmental delay (DD). The aim of this study was to detect the differences in performance of a sample of apparently healthy Egyptian infants and toddlers on the Bayley-III scales in relation to their age and gender. METHODS This was a cross-sectional study. Bayley scales were applied to 270 of the 300 recruited children following the inclusion criteria; to avoid potential risk factors affecting development. Assessment included cognitive, language and motor skills. Engaged children aged 18-42 months were divided into 4 age groups with six-month intervals. RESULTS Approximately 78.4%, 76.2%, and 72% of the participants had average and above average scores in the cognitive, motor, and language domains, respectively. The language domain was characteristically impacted. The oldest age group (36-42 months) scored the highest means composite scores, while the 2nd group aged 24 - <30 months, scored the lowest means in the three evaluated domains. In general, girls had non-significantly higher composite scores than boys, with a small effect size (d = 0.2-0.4). In the language domain, girls aged 30 to < 36 months scored significantly higher composite scores than boys (p < 0.05), with a medium effect size (d = 0.73). CONCLUSION The study indicates that the performance of apparently healthy Egyptian children on the Bayley III evaluation differs in relation to age and sex. The most vulnerable age group at potential risk of DD was children aged 24-30 months. Efforts must be directed to investigate the nutritional, physical, psychological and safety needs of this group. Attention must be paid to early childhood intervention programs that stimulate development, especially language development, and they must be tailored on the basis of age and gender. Gender-specific norms may be needed in the evaluation of language development.
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Affiliation(s)
- Zeinab M Monir
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Ebtissam M Salah El-Din
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Wafaa A Kandeel
- Biological Anthropology Department/Medical Research and Clinical Studies Institute, National Research Centre, 60014618, Cairo, Dokki, Egypt
| | - Sara F Sallam
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Eman Elsheikh
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Mones M Abushady
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Fawzia Hasseb Allah
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Sawsan Tawfik
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt
| | - Dina Abu Zeid
- Child Health Department/Medical Research and Clinical Studies Institute, National Research Centre, 33 El Bohouth st, 60014618, Cairo, Dokki, Egypt.
- Child Health Department Medical Research and Clinical Studies Institute, National Research Centre, P.O.12622, Cairo, Egypt.
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19
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Sood E, Newburger JW, Anixt JS, Cassidy AR, Jackson JL, Jonas RA, Lisanti AJ, Lopez KN, Peyvandi S, Marino BS. Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e997-e1022. [PMID: 38385268 DOI: 10.1161/cir.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.
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20
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Lamon S, de Dumast P, Sanchez T, Dunet V, Pomar L, Vial Y, Koob M, Bach Cuadra M. Assessment of fetal corpus callosum biometry by 3D super-resolution reconstructed T2-weighted magnetic resonance imaging. Front Neurol 2024; 15:1358741. [PMID: 38595845 PMCID: PMC11002102 DOI: 10.3389/fneur.2024.1358741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Objective To assess the accuracy of corpus callosum (CC) biometry, including sub-segments, using 3D super-resolution fetal brain MRI (SR) compared to 2D or 3D ultrasound (US) and clinical low-resolution T2-weighted MRI (T2WS). Method Fetal brain biometry was conducted by two observers on 57 subjects [21-35 weeks of gestational age (GA)], including 11 cases of partial CC agenesis. Measures were performed by a junior observer (obs1) on US, T2WS and SR and by a senior neuroradiologist (obs2) on T2WS and SR. CC biometric regression with GA was established. Statistical analysis assessed agreement within and between modalities and observers. Results This study shows robust SR to US concordance across gestation, surpassing T2WS. In obs1, SR aligns with US, except for genu and CC length (CCL), enhancing splenium visibility. In obs2, SR closely corresponds to US, differing in rostrum and CCL. The anterior CC (rostrum and genu) exhibits higher variability. SR's regression aligns better with literature (US) for CCL, splenium and body than T2WS. SR is the method with the least missing values. Conclusion SR yields CC biometry akin to US (excluding anterior CC). Thanks to superior 3D visualization and better through plane spatial resolution, SR allows to perform CC biometry more frequently than T2WS.
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Affiliation(s)
- Samuel Lamon
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Priscille de Dumast
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
| | - Thomas Sanchez
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Léo Pomar
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Yvan Vial
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Mériam Koob
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
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21
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Nijman M, van der Meeren LE, Nikkels PGJ, Stegeman R, Breur JMPJ, Jansen NJG, ter Heide H, Steenhuis TJ, de Heus R, Bekker MN, Claessens NHP, Benders MJNL. Placental Pathology Contributes to Impaired Volumetric Brain Development in Neonates With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e033189. [PMID: 38420785 PMCID: PMC10944035 DOI: 10.1161/jaha.123.033189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Neonates with congenital heart disease are at risk for impaired brain development in utero, predisposing children to postnatal brain injury and adverse long-term neurodevelopmental outcomes. Given the vital role of the placenta in fetal growth, we assessed the incidence of placental pathology in fetal congenital heart disease and explored its association with total and regional brain volumes, gyrification, and brain injury after birth. METHODS AND RESULTS Placentas from 96 term singleton pregnancies with severe fetal congenital heart disease were prospectively analyzed for macroscopic and microscopic pathology. We applied a placental pathology severity score to relate placental abnormalities to neurological outcome. Postnatal, presurgical magnetic resonance imaging was used to analyze brain volumes, gyrification, and brain injuries. Placental analyses revealed the following abnormalities: maternal vascular malperfusion lesions in 46%, nucleated red blood cells in 37%, chronic inflammatory lesions in 35%, delayed maturation in 30%, and placental weight below the 10th percentile in 28%. Severity of placental pathology was negatively correlated with cortical gray matter, deep gray matter, brainstem, cerebellar, and total brain volumes (r=-0.25 to -0.31, all P<0.05). When correcting for postmenstrual age at magnetic resonance imaging in linear regression, this association remained significant for cortical gray matter, cerebellar, and total brain volume (adjusted R2=0.25-0.47, all P<0.05). CONCLUSIONS Placental pathology occurs frequently in neonates with severe congenital heart disease and may contribute to impaired brain development, indicated by the association between placental pathology severity and reductions in postnatal cortical, cerebellar, and total brain volumes.
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Affiliation(s)
- Maaike Nijman
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Lotte E. van der Meeren
- Department of PathologyErasmus Medical Center RotterdamRotterdamthe Netherlands
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Peter G. J. Nikkels
- Department of PathologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Raymond Stegeman
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of PediatricsBeatrix Children’s Hospital, University Medical Center GroningenGroningenthe Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Nicolaas J. G. Jansen
- Department of PediatricsBeatrix Children’s Hospital, University Medical Center GroningenGroningenthe Netherlands
| | - Henriette ter Heide
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Trinette J. Steenhuis
- Department of Pediatric CardiologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Roel de Heus
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtthe Netherlands
- Department of Obstetrics and GynecologySt. Antonius HospitalUtrechtthe Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Nathalie H. P. Claessens
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
- Department of PediatricsWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| | - Manon J. N. L. Benders
- Department of NeonatologyWilhelmina Children’s Hospital, University Medical Center UtrechtUtrechtthe Netherlands
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22
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Vasserman M, Myers K, Brooks BL, Fay-McClymont TB, McColm L, Mish S, Becker N, MacAllister WS. Patterns of WISC-V Performance in Children with Congenital Heart Disease. Pediatr Cardiol 2024; 45:483-490. [PMID: 38214737 DOI: 10.1007/s00246-023-03367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
Congenital heart disease (CHD) is one of the most common congenital birth defects. As surgical and interventional techniques have improved, the mortality has been greatly reduced and the focus has shifted to quality of life and long-term outcomes. The impact of CHD on development and cognition is becoming increasingly recognized. However, more research is needed to understand how children with CHD perform across various cognitive and intellectual domains. This study explored the performance of children with CHD on the newest version of the Wechsler Intelligence Scale for Children compared to normative controls. Children with CHD performed more poorly than normal controls across all indices and most subtests with large effect sizes. Additionally, we explored the patterns of impairment across indices and subtests, as well as the relationships between heard disease variables and WISC-V performance. Block design, Digit Span, and Similarities were the most commonly impaired scores in children with CHD, while Symbol Search, Picture Span, Figure Weights, and Vocabulary were least likely to be impaired.
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Affiliation(s)
- Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
- Department of Pediatrics, University of Calgary, Calgary, Canada.
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada.
| | - Kimberly Myers
- Cardiology, Alberta Children's Hospital, Calgary, Canada
- Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
- Departments of Pediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
| | - Taryn B Fay-McClymont
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
- Private Practice, Kelowna, Canada
| | - Lisa McColm
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Norma Becker
- Cardiology, Alberta Children's Hospital, Calgary, Canada
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Child Brain and Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Canada
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23
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Gabriel GC, Yagi H, Tan T, Bais AS, Glennon BJ, Stapleton MC, Huang L, Reynolds WT, Shaffer MG, Ganapathiraju M, Simon D, Panigrahy A, Wu YL, Lo CW. Mitotic Block and Epigenetic Repression Underlie Neurodevelopmental Defects and Neurobehavioral Deficits in Congenital Heart Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.05.565716. [PMID: 38464057 PMCID: PMC10925221 DOI: 10.1101/2023.11.05.565716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Poor neurodevelopment is often observed with congenital heart disease (CHD), especially with mutations in chromatin modifiers. Here analysis of mice with hypoplastic left heart syndrome (HLHS) arising from mutations in Sin3A associated chromatin modifier Sap130 , and adhesion protein Pcdha9, revealed neurodevelopmental and neurobehavioral deficits reminiscent of those in HLHS patients. Microcephaly was associated with impaired cortical neurogenesis, mitotic block, and increased apoptosis. Transcriptional profiling indicated dysregulated neurogenesis by REST, altered CREB signaling regulating memory and synaptic plasticity, and impaired neurovascular coupling modulating cerebral blood flow. Many neurodevelopmental/neurobehavioral disease pathways were recovered, including autism and cognitive impairment. These same pathways emerged from genome-wide DNA methylation and Sap130 chromatin immunoprecipitation sequencing analyses, suggesting epigenetic perturbation. Mice with Pcdha9 mutation or forebrain-specific Sap130 deletion without CHD showed learning/memory deficits and autism-like behavior. These novel findings provide mechanistic insights indicating the adverse neurodevelopment in HLHS may involve cell autonomous/nonautonomous defects and epigenetic dysregulation and suggest new avenues for therapy.
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Abhinav P, Li YJ, Huang RT, Liu XY, Gu JN, Yang CX, Xu YJ, Wang J, Yang YQ. Somatic GATA4 mutation contributes to tetralogy of Fallot. Exp Ther Med 2024; 27:91. [PMID: 38274337 PMCID: PMC10809308 DOI: 10.3892/etm.2024.12379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Tetralogy of Fallot (TOF) is the most prevalent cyanotic congenital heart pathology and causes infant morbidity and mortality worldwide. GATA-binding protein 4 (GATA4) serves as a pivotal transcriptional factor for embryonic cardiogenesis and germline GATA4 mutations are causally linked to TOF. However, the effects of somatic GATA4 mutations on the pathogenesis of TOF remain to be ascertained. In the present study, sequencing assay of GATA4 was performed utilizing genomic DNA derived from resected heart tissue specimens as well as matched peripheral blood specimens of 62 patients with non-familial TOF who underwent surgical treatment for TOF. Sequencing of GATA4 was also performed using the heart tissue specimens as well as matched peripheral venous blood samples of 68 sporadic cases who underwent heart valve displacement because of rheumatic heart disorder and the peripheral venous whole blood samples of 216 healthy subjects. The function of the mutant was explored by dual-luciferase activity analysis. Consequently, a new GATA4 mutation, NM_002052.5:c.708T>G;p.(Tyr236*), was found in the heart tissue of one patient with TOF. No mutation was detected in the heart tissue of the 68 cases suffering from rheumatic heart disorder or in the venous blood samples of all 346 individuals. GATA4 mutant failed to transactivate its target gene, myosin heavy chain 6. Additionally, this mutation nullified the synergistic transactivation between GATA4 and T-box transcription factor 5 or NK2 homeobox 5, two genes causative for TOF. Somatic GATA4 mutation predisposes TOF, highlighting the significant contribution of somatic variations to the molecular pathogenesis underpinning TOF.
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Affiliation(s)
- Pradhan Abhinav
- Department of Cardiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P.R. China
| | - Ri-Tai Huang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, P.R. China
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
| | - Jia-Ning Gu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, P.R. China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, P.R. China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, P.R. China
| | - Juan Wang
- Department of Cardiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, P.R. China
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, P.R. China
- Central Laboratory, Shanghai Fifth People's Hospital, Fudan University, Shanghai 200240, P.R. China
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25
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Dong BB, Li YJ, Liu XY, Huang RT, Yang CX, Xu YJ, Lv HT, Yang YQ. Discovery of BMP10 as a new gene underpinning congenital heart defects. Am J Transl Res 2024; 16:109-125. [PMID: 38322548 PMCID: PMC10839403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Aggregating evidence convincingly establishes the predominant genetic basis underlying congenital heart defects (CHD), though the heritable determinants contributing to CHD in the majority of cases remain elusive. In the current investigation, BMP10 was selected as a prime candidate gene for human CHD mainly due to cardiovascular developmental abnormalities in Bmp10-knockout animals. The objective of this retrospective study was to identify a new BMP10 mutation responsible for CHD and characterize the functional effect of the identified CHD-causing BMP10 mutation. METHODS Sequencing assay of BMP10 was fulfilled in a cohort of 276 probands with various CHD and a total of 288 non-CHD volunteers. The available family members from the proband harboring an identified BMP10 mutation were also BMP10-genotyped. The effect of the identified CHD-causative BMP10 mutation on the transactivation of TBX20 and NKX2.5 by BMP10 was quantitatively analyzed in maintained HeLa cells utilizing a dual-luciferase reporter assay system. RESULTS A novel heterozygous BMP10 mutation, NM_014482.3:c.247G>T;p.(Glu83*), was identified in one proband with patent ductus arteriosus (PDA), which was confirmed to co-segregate with the PDA phenotype in the mutation carrier's family. The nonsense mutation was not observed in 288 non-CHD volunteers. Functional analysis unveiled that Glu83*-mutant BMP10 had no transactivation on its two representative target genes TBX20 and NKX2.5, which were both reported to cause CHD. CONCLUSION These findings provide strong evidence indicating that genetically compromised BMP10 predisposes human beings to CHD, which sheds light on the new molecular mechanism that underlies CHD and allows for antenatal genetic counseling and individualized precise management of CHD.
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Affiliation(s)
- Bin-Bin Dong
- Department of Cardiology, Children’s Hospital of Soochow UniversitySuzhou 215003, Jiangsu, China
| | - Yan-Jie Li
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200030, China
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of MedicineShanghai 200065, China
| | - Ri-Tai Huang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200127, China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
| | - Hai-Tao Lv
- Department of Cardiology, Children’s Hospital of Soochow UniversitySuzhou 215003, Jiangsu, China
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
- Department of Cardiovascular Research Laboratory, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
- Department of Central Laboratory, Shanghai Fifth People’s Hospital, Fudan UniversityShanghai 200240, China
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26
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Sadhwani A, Sood E, Van Bergen AH, Ilardi D, Sanz JH, Gaynor JW, Seed M, Ortinau CM, Marino BS, Miller TA, Gaies M, Cassidy AR, Donohue JE, Ardisana A, Wypij D, Goldberg CS. Development of the data registry for the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2024; 34:79-85. [PMID: 37203794 DOI: 10.1017/s1047951123001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Children with congenital heart disease (CHD) can face neurodevelopmental, psychological, and behavioural difficulties beginning in infancy and continuing through adulthood. Despite overall improvements in medical care and a growing focus on neurodevelopmental screening and evaluation in recent years, neurodevelopmental disabilities, delays, and deficits remain a concern. The Cardiac Neurodevelopmental Outcome Collaborative was founded in 2016 with the goal of improving neurodevelopmental outcomes for individuals with CHD and pediatric heart disease. This paper describes the establishment of a centralised clinical data registry to standardize data collection across member institutions of the Cardiac Neurodevelopmental Outcome Collaborative. The goal of this registry is to foster collaboration for large, multi-centre research and quality improvement initiatives that will benefit individuals and families with CHD and improve their quality of life. We describe the components of the registry, initial research projects proposed using data from the registry, and lessons learned in the development of the registry.
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Affiliation(s)
- Anjali Sadhwani
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Erica Sood
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew H Van Bergen
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Dawn Ilardi
- Department of Rehabilitation Medicine, Emory University, and the Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jacqueline H Sanz
- Division of Neuropsychology, Children's National Hospital, and Departments of Psychiatry and Behavioral Science and Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Seed
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada
| | - Cynthia M Ortinau
- Department of Pediatrics, Washington University in St. Louis. St. Louis. MO, USA
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Thomas A Miller
- Division of Pediatric Cardiology, Maine Medical Center, Portland, ME, USA
| | - Michael Gaies
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam R Cassidy
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Departments of Psychiatry and Psychology, and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janet E Donohue
- Cardiac Networks United Data Core, University of Michigan, Ann Arbor, MI, USA
| | | | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Caren S Goldberg
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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27
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Phillips K, Callaghan B, Rajagopalan V, Akram F, Newburger JW, Kasparian NA. Neuroimaging and Neurodevelopmental Outcomes Among Individuals With Complex Congenital Heart Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:2225-2245. [PMID: 38030353 DOI: 10.1016/j.jacc.2023.09.824] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023]
Abstract
Although neuroimaging advances have deepened our understanding of brain health in individuals with congenital heart disease (CHD), it is less clear how neuroimaging findings relate to neurodevelopmental and mental health outcomes across the lifespan. We systematically synthesized and critically evaluated evidence on associations between neuroimaging and neurodevelopmental, neurocognitive, psychiatric, or behavioral outcomes among individuals with transposition of great arteries or single-ventricle CHD (Protocol CRD42021229617). Six databases were searched and 45 papers from 25 unique studies were identified. Structural brain injury was generally linked to poorer neurodevelopment in infancy. Brain volumes and microstructural and functional brain changes appear linked to neurocognitive outcomes, including deficits in attention, learning, memory, and executive function in children and adolescents. Fetal neuroimaging studies were limited. Four papers investigated psychiatric outcomes; none found associations with neuroimaging. Multicenter, longitudinal studies incorporating functional neuroimaging and mental health outcomes are much-needed to inform early neuroprotective and therapeutic strategies in CHD.
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Affiliation(s)
- Katelyn Phillips
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bridget Callaghan
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Vidya Rajagopalan
- Department of Radiology, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Farah Akram
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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28
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Dijkhuizen EI, de Munck S, de Jonge RCJ, Dulfer K, van Beynum IM, Hunfeld M, Rietman AB, Joosten KFM, van Haren NEM. Early brain magnetic resonance imaging findings and neurodevelopmental outcome in children with congenital heart disease: A systematic review. Dev Med Child Neurol 2023; 65:1557-1572. [PMID: 37035939 DOI: 10.1111/dmcn.15588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023]
Abstract
AIM To investigate the association between early brain magnetic resonance imaging (MRI) findings and neurodevelopmental outcome (NDO) in children with congenital heart disease (CHD). METHOD A search for studies was conducted in Embase, Medline, Web of Science, Cochrane Central, PsycINFO, and Google Scholar. Observational and interventional studies were included, in which patients with CHD underwent surgery before 2 months of age, a brain MRI scan in the first year of life, and neurodevelopmental assessment beyond the age of 1 year. RESULTS Eighteen studies were included. Thirteen found an association between either quantitative or qualitative brain metrics and NDO: 5 out of 7 studies showed decreased brain volume was significantly associated with worse NDO, as did 7 out of 10 studies on brain injury. Scanning protocols and neurodevelopmental tests varied strongly. INTERPRETATION Reduced brain volume and brain injury in patients with CHD can be associated with impaired NDO, yet standardized scanning protocols and neurodevelopmental assessment are needed to further unravel trajectories of impaired brain development and its effects on outcome.
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Affiliation(s)
- Emma I Dijkhuizen
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sophie de Munck
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Karolijn Dulfer
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Maayke Hunfeld
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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29
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Sanz JH, Cox S, Donofrio MT, Ishibashi N, McQuillen P, Peyvandi S, Schlatterer S. [Formula: see text] Trajectories of neurodevelopment and opportunities for intervention across the lifespan in congenital heart disease. Child Neuropsychol 2023; 29:1128-1154. [PMID: 36752083 PMCID: PMC10406974 DOI: 10.1080/09297049.2023.2173162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
Children with congenital heart disease (CHD) are at increased risk for neurodevelopmental challenges across the lifespan. These are associated with neurological changes and potential acquired brain injury, which occur across a developmental trajectory and which are influenced by an array of medical, sociodemographic, environmental, and personal factors. These alterations to brain development lead to an array of adverse neurodevelopmental outcomes, which impact a characteristic set of skills over the course of development. The current paper reviews existing knowledge of aberrant brain development and brain injury alongside associated neurodevelopmental challenges across the lifespan. These provide a framework for discussion of emerging and potential interventions to improve neurodevelopmental outcomes at each developmental stage.
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Affiliation(s)
- Jacqueline H Sanz
- Division of Neuropsychology, Children's National Hospital, Washington, D.C
- Departments of Psychiatry and Behavioral Sciences & Pediatrics at The George Washington University School of Medicine
| | - Stephany Cox
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Health System, Washington, D.C
- Department of Pediatrics at The George Washington University School of Medicine
| | - Nobuyuki Ishibashi
- Department of Pediatrics at The George Washington University School of Medicine
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington D.C
| | - Patrick McQuillen
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Shabnam Peyvandi
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Sarah Schlatterer
- Department of Pediatrics at The George Washington University School of Medicine
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, D.C
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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30
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Cassidy AR, Neumann AA. [Formula: see text] Optimizing neurodevelopmental outcomes following fetal diagnosis of congenital heart disease: a call for primary prevention neuropsychology. Child Neuropsychol 2023; 29:1155-1177. [PMID: 36942716 DOI: 10.1080/09297049.2023.2190966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Critical congenital heart disease (CHD) presents a lasting threat to quality of life through its adverse impact on neurodevelopmental and psychosocial outcomes. As recognition of this threat has increased, so too has an appreciation for the role of pediatric neuropsychologists in supporting families affected by CHD. But there is more to offer these families than traditional neuropsychological services, which tend to focus on secondary/tertiary forms of prevention. Now that many children with CHD are diagnosed prenatally, it may be possible to begin mitigating CHD-related risks and promoting positive outcomes earlier than ever before. Through primary prevention-oriented fetal neuropsychological consultation, as well as close collaboration with allied specialists, pediatric neuropsychology has an opportunity to re-envision its typical borders and more familiar practice models; to forge early and enduring partnerships with families; and to help promote the best possible neurodevelopmental trajectories, beginning before children are even born. In this conceptual review, we survey and integrate evidence from developmental science, developmental origins of health and disease, maternal-fetal medicine, and cardiac neurodevelopmental literatures, along with current practice norms, arriving ultimately at two central conclusions: 1) there is an important role to fill on multidisciplinary teams for the pediatric neuropsychologist in fetal cardiac care and 2) role expansion (e.g., through valuing broader-based training, flexing more generalist skills) can likely improve neuropsychological outcomes earlier than has been standard for pediatric neuropsychologists. Such a reimagining of our practice may be considered primary prevention neuropsychology. Implications for care in various settings and pragmatic barriers to implementation are discussed.
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Affiliation(s)
- Adam R Cassidy
- Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa A Neumann
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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31
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Andescavage NN, Pradhan S, Gimovsky AC, Kapse K, Donofrio MT, Cheng JJ, Sharker Y, Wessel D, du Plessis AJ, Limperopoulos C. Magnetic Resonance Spectroscopy of Brain Metabolism in Fetuses With Congenital Heart Disease. J Am Coll Cardiol 2023; 82:1614-1623. [PMID: 37821172 DOI: 10.1016/j.jacc.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) remains a significant risk factor for neurologic injury because altered fetal hemodynamics may be unable to support typical brain development during critical periods of growth and maturation. OBJECTIVES The primary objective was to assess differences in the cerebral biochemical profile between healthy fetuses and fetuses with complex CHD and to relate these with infant outcomes. METHODS Pregnant participants underwent fetal magnetic resonance imaging with cerebral proton magnetic resonance spectroscopy acquisitions as part of a prospective observational study. Cerebral metabolites of N-acetyl aspartate, creatine, choline, myo-inositol, scyllo-inositol, lactate, and relevant ratios were quantified using LCModel. RESULTS We acquired 503 proton magnetic resonance spectroscopy images (controls = 333; CHD = 170) from 333 participants (controls = 221; CHD = 112). Mean choline levels were higher in CHD compared with controls (CHD 2.47 IU [Institutional Units] ± 0.44 and Controls 2.35 IU ± 0.45; P = 0.02), whereas N-acetyl aspartate:choline ratios were lower among CHD fetuses compared with controls (CHD 1.34 ± 0.40 IU vs controls 1.44 ± 0.48 IU; P = 0.001). Cerebral lactate was detected in all cohorts but increased in fetuses with transposition of the great arteries and single-ventricle CHD (median: 1.63 [IQR: 0.56-3.27] in transposition of the great arteries and median: 1.28 [IQR: 0-2.42] in single-ventricle CHD) compared with 2-ventricle CHD (median: 0.79 [IQR: 0-1.45]). Cerebral lactate also was associated with increased odds of death before discharge (OR: 1.75; P = 0.04). CONCLUSIONS CHD is associated with altered cerebral metabolites in utero, particularly in the third trimester period of pregnancy, which is characterized by exponential brain growth and maturation, and is associated with survival to hospital discharge. The long-term neurodevelopmental consequences of these findings warrant further study.
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Affiliation(s)
- Nickie N Andescavage
- Department of Neonatology, Children's National Hospital, Washington, DC, USA; Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Subechhya Pradhan
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Mary T Donofrio
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Jenhao Jacob Cheng
- Department of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Yushuf Sharker
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - David Wessel
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Adre J du Plessis
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Prenatal Pediatric Institute, Children's National Hospital, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Radiology, Children's National Hospital, Washington, DC, USA; Department of Radiology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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32
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Panigrahy A, Blüml S, Rajagopalan V. Altered In Utero Metabolic Brain Trajectories in CHD: Going Beyond Fetal Brain Structure and Physiology. J Am Coll Cardiol 2023; 82:1624-1627. [PMID: 37821173 PMCID: PMC11136159 DOI: 10.1016/j.jacc.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, Bioengineering, Bioinformatics and Developmental Biology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Stefan Blüml
- Department of Radiology, Children's Hospital of Los Angeles, Keck School of Medicine and Biomedical Engineering, USC, Los Angeles, California, USA
| | - Vidya Rajagopalan
- Department of Pediatrics and Radiology, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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33
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Shrot S, Hadi E, Barash Y, Hoffmann C. Effect of magnet strength on fetal brain biometry - a single-center retrospective MRI-based cohort study. Neuroradiology 2023; 65:1517-1525. [PMID: 37436475 DOI: 10.1007/s00234-023-03193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Abnormal fetal brain measurements might affect clinical management and parental counseling. The effect of between-field-strength differences was not evaluated in quantitative fetal brain imaging until now. Our study aimed to compare fetal brain biometry measurements in 3.0 T with 1.5 T scanners. METHODS A retrospective cohort of 1150 low-risk fetuses scanned between 2012 and 2021, with apparently normal brain anatomy, were retrospectively evaluated for biometric measurements. The cohort included 1.5 T (442 fetuses) and 3.0 T scans (708 fetuses) of populations with comparable characteristics in the same tertiary medical center. Manually measured biometry included bi-parietal, fronto-occipital and trans-cerebellar diameters, length of the corpus-callosum, vermis height, and width. Measurements were then converted to centiles based on previously reported biometric reference charts. The 1.5 T centiles were compared with the 3.0 T centiles. RESULTS No significant differences between centiles of bi-parietal diameter, trans-cerebellar diameter, or length of the corpus callosum between 1.5 T and 3.0 T scanners were found. Small absolute differences were found in the vermis height, with higher centiles in the 3.0 T, compared to the 1.5 T scanner (54.6th-centile, vs. 39.0th-centile, p < 0.001); less significant differences were found in vermis width centiles (46.9th-centile vs. 37.5th-centile, p = 0.03). Fronto-occipital diameter was higher in 1.5 T than in the 3.0 T scanner (66.0th-centile vs. 61.8th-centile, p = 0.02). CONCLUSIONS The increasing use of 3.0 T MRI for fetal imaging poses a potential bias when using 1.5 T-based charts. We elucidate those biometric measurements are comparable, with relatively small between-field-strength differences, when using manual biometric measurements. Small inter-magnet differences can be related to higher spatial resolution with 3 T scanners and may be substantial when evaluating small brain structures, such as the vermis.
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Affiliation(s)
- Shai Shrot
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 2 Sheba Rd, 52621, Ramat Gan, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Hadi
- Diagnostic Ultrasound Unit of the Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, 52621, Ramat Gan, Israel
| | - Yiftach Barash
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 2 Sheba Rd, 52621, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Hoffmann
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 2 Sheba Rd, 52621, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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De Asis-Cruz J, Kim JH, Krishnamurthy D, Lopez C, Kapse K, Andescavage N, Vezina G, Limperopoulos C. Examining the relationship between fetal cortical thickness, gestational age, and maternal psychological distress. Dev Cogn Neurosci 2023; 63:101282. [PMID: 37515833 PMCID: PMC10407290 DOI: 10.1016/j.dcn.2023.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
In utero exposure to maternal stress, anxiety, and depression has been associated with reduced cortical thickness (CT), and CT changes, in turn, to adverse neuropsychiatric outcomes. Here, we investigated global and regional (G/RCT) changes associated with fetal exposure to maternal psychological distress in 265 brain MRI studies from 177 healthy fetuses of low-risk pregnant women. GCT was measured from cortical gray matter (CGM) voxels; RCT was estimated from 82 cortical regions. GCT and RCT in 87% of regions strongly correlated with GA. Fetal exposure was most strongly associated with RCT in the parahippocampal region, ventromedial prefrontal cortex, and supramarginal gyrus suggesting that cortical alterations commonly associated with prenatal exposure could emerge in-utero. However, we note that while regional fetal brain involvement conformed to patterns observed in newborns and children exposed to prenatal maternal psychological distress, the reported associations did not survive multiple comparisons correction. This could be because the effects are more subtle in this early developmental window or because majority of the pregnant women in our study did not experience high levels of maternal distress. It is our hope that the current findings will spur future hypothesis-driven studies that include a full spectrum of maternal mental health scores.
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Affiliation(s)
| | - Jung-Hoon Kim
- Developing Brain Institute, Children's National, Washington, DC, USA
| | | | - Catherine Lopez
- Developing Brain Institute, Children's National, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National, Washington, DC, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children's National, Washington, DC, USA; Division of Neonatology, Children's National Medical Center, Washington, DC, USA
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National, Washington, DC, USA; Division of Diagnostic Imaging and Radiology, Children's National, Washington, DC, USA.
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Rogers SC, Malik L, Fogel J, Hamilton B, Huisenga D, Lewis-Wolf C, Mieczkowski D, Peterson JK, Russell S, Schmelzer AC, Smith J, Butler SC. Optimising motor development in the hospitalised infant with CHD: factors contributing to early motor challenges and recommendations for assessment and intervention. Cardiol Young 2023; 33:1800-1812. [PMID: 37727892 DOI: 10.1017/s1047951123003165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists' role in caring for infants with critical CHD in intensive or acute care hospital units. PURPOSE This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed. CONCLUSIONS Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant's overall development.
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Affiliation(s)
- Stefanie C Rogers
- Children's Health Rehabilitation and Therapy Services, Children's Medical Center Dallas, Dallas, TX, USA
| | - Lauren Malik
- Primary Children's Hospital, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | - Anne C Schmelzer
- Duke University Pediatric and Congenital Heart Center, Durham, NC, USA
| | - Jodi Smith
- The Mended Hearts, Inc., Leesburg, GA, USA
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Elgersma KM, Wolfson J, Fulkerson JA, Georgieff MK, Looman WS, Spatz DL, Shah KM, Uzark K, McKechnie AC. Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score-Matched Analysis of the NPC-QIC Registry. J Am Heart Assoc 2023; 12:e030756. [PMID: 37642030 PMCID: PMC10547322 DOI: 10.1161/jaha.123.030756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
Background Infants with single ventricle congenital heart disease undergo 3 staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding on outcomes including necrotizing enterocolitis, infection-related complications, length of stay, and mortality. Methods and Results We analyzed the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry (2016-2021), examining HM/breastfeeding groups during stage 1 and stage 2 palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/breastfeeding groups. Infants fed exclusive HM before stage 1 palliation (S1P) had lower odds of preoperative necrotizing enterocolitis (odds ratio [OR], 0.37 [95% CI, 0.17-0.84]; P=0.017) and shorter S1P length of stay (rate ratio [RR], 0.87 [95% CI, 0.78-0.98]; P=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative necrotizing enterocolitis (OR, 0.28 [95% CI, 0.15-0.50]; P<0.001) and sepsis (OR, 0.29 [95% CI, 0.13-0.65]; P=0.003), and shorter S1P length of stay (RR, 0.75 [95% CI, 0.66-0.86]; P<0.001). At stage 2 palliation, infants with any HM (RR, 0.82 [95% CI, 0.69-0.97]; P=0.018) and any breastfeeding (RR, 0.71 [95% CI, 0.57-0.89]; P=0.003) experienced shorter length of stay. Conclusions Infants with single ventricle congenital heart disease in high-HM and breastfeeding groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/breastfeeding in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader congenital heart disease populations, and should examine mechanisms (eg, HM components, microbiome) by which HM/breastfeeding benefits these infants.
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Affiliation(s)
| | - Julian Wolfson
- Division of BiostatisticsUniversity of Minnesota School of Public HealthMinneapolisMNUSA
| | - Jayne A. Fulkerson
- University of Minnesota School of NursingMinneapolisMNUSA
- Division of EpidemiologyUniversity of Minnesota School of Public HealthMinneapolisMNUSA
| | - Michael K. Georgieff
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMNUSA
- M Health Fairview University of Minnesota Masonic Children’s HospitalMinneapolisMNUSA
| | | | - Diane L. Spatz
- University of Pennsylvania School of NursingPhiladelphiaPAUSA
- Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Kavisha M. Shah
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMNUSA
- M Health Fairview University of Minnesota Masonic Children’s HospitalMinneapolisMNUSA
| | - Karen Uzark
- Division of Cardiac SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- C. S. Mott Children’s HospitalAnn ArborMIUSA
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Lu JLA, Resta S, Marra MC, Patelli C, Stefanachi V, Rizzo G. Validation of an automatic software in assessing fetal brain volume from three dimensional ultrasonographic volumes: Comparison with manual analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1146-1151. [PMID: 37307382 DOI: 10.1002/jcu.23509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study was aimed to test the agreement between a manual and an automatic technique in measuring fetal brain volume (FBV) from three-dimensional (3D) fetal head datasets. METHODS FBV were acquired independently by two operators from low risk singleton pregnancies at a gestational age between 19 and 34 weeks. FBV measurements were obtained using an automatic software (Smart ICV™) and manually by Virtual Organ Computer-aided AnaLysis (VOCAL™). Intraclass correlation coefficient (ICC) were calculated to assess reliability, while bias and agreement were evaluate by examining Bland-Altman plots. The time spent in measuring volumes was calculated and values obtained compared. RESULTS Sixty-three volumes were considered for the study. In all the included volumes successful volume analysis were obtained with both techniques. Smart ICV™ showed a high intra-observer (0.996; 95% CI 0.994-0.998) and inter-observer (ICC 0.995; 95% CI 0.991-0.997). An excellent degree of reliability was found when the two techniques were compared (ICC 0.995; 95% CI 0.987-0.998). The time required to perform FBV was significantly lower for Smart ICV™ than VOCAL™ (8.2 ± 4.5 vs. 121.3 ± 19.0 s; p < 0.0001). CONCLUSIONS The measurement of FBV is feasible with both manual and automatic techniques. Smart ICV™ showed an excellent intra- and inter-observer reliability associated with a valuable agreement with volume measurements obtained manually with VOCAL™. Volumes may be measured significantly faster with smart ICV™ than manually and this automatic software has the potential to become the preferred methods for the assessment of FBV.
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Affiliation(s)
- Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Serena Resta
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Chiara Patelli
- Department of Obstetrics and Gynecology, Università di Veroma, Verona, Italy
| | - Vitaliana Stefanachi
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
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38
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Grisolia G, Pinto A. Smart ICV™ versus VOCAL™ in fetal brain volume assessment: Can we begin to trust artificial intelligence in clinical practice? JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1152-1154. [PMID: 37431153 DOI: 10.1002/jcu.23521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
This paper is a commentary about an interesting research conducted with the aim of testing the agreement between manual versus automatic technique in measuring fetal brain volume. Given the high degree of reliability between the two techniques, we hope that the new automatic software can become useful tools in identifying fetuses with reduced brain volume at high risk of adverse neurological outcome.
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Affiliation(s)
- Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
| | - Alessia Pinto
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
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39
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Payette K, Li HB, de Dumast P, Licandro R, Ji H, Siddiquee MMR, Xu D, Myronenko A, Liu H, Pei Y, Wang L, Peng Y, Xie J, Zhang H, Dong G, Fu H, Wang G, Rieu Z, Kim D, Kim HG, Karimi D, Gholipour A, Torres HR, Oliveira B, Vilaça JL, Lin Y, Avisdris N, Ben-Zvi O, Bashat DB, Fidon L, Aertsen M, Vercauteren T, Sobotka D, Langs G, Alenyà M, Villanueva MI, Camara O, Fadida BS, Joskowicz L, Weibin L, Yi L, Xuesong L, Mazher M, Qayyum A, Puig D, Kebiri H, Zhang Z, Xu X, Wu D, Liao K, Wu Y, Chen J, Xu Y, Zhao L, Vasung L, Menze B, Cuadra MB, Jakab A. Fetal brain tissue annotation and segmentation challenge results. Med Image Anal 2023; 88:102833. [PMID: 37267773 DOI: 10.1016/j.media.2023.102833] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 06/04/2023]
Abstract
In-utero fetal MRI is emerging as an important tool in the diagnosis and analysis of the developing human brain. Automatic segmentation of the developing fetal brain is a vital step in the quantitative analysis of prenatal neurodevelopment both in the research and clinical context. However, manual segmentation of cerebral structures is time-consuming and prone to error and inter-observer variability. Therefore, we organized the Fetal Tissue Annotation (FeTA) Challenge in 2021 in order to encourage the development of automatic segmentation algorithms on an international level. The challenge utilized FeTA Dataset, an open dataset of fetal brain MRI reconstructions segmented into seven different tissues (external cerebrospinal fluid, gray matter, white matter, ventricles, cerebellum, brainstem, deep gray matter). 20 international teams participated in this challenge, submitting a total of 21 algorithms for evaluation. In this paper, we provide a detailed analysis of the results from both a technical and clinical perspective. All participants relied on deep learning methods, mainly U-Nets, with some variability present in the network architecture, optimization, and image pre- and post-processing. The majority of teams used existing medical imaging deep learning frameworks. The main differences between the submissions were the fine tuning done during training, and the specific pre- and post-processing steps performed. The challenge results showed that almost all submissions performed similarly. Four of the top five teams used ensemble learning methods. However, one team's algorithm performed significantly superior to the other submissions, and consisted of an asymmetrical U-Net network architecture. This paper provides a first of its kind benchmark for future automatic multi-tissue segmentation algorithms for the developing human brain in utero.
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Affiliation(s)
- Kelly Payette
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
| | - Hongwei Bran Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland; Department of Informatics, Technical University of Munich, Munich, Germany
| | - Priscille de Dumast
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM, Center for Biomedical Imaging, Lausanne, Switzerland
| | - Roxane Licandro
- Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA, United States; Department of Biomedical Imaging and Image-guided Therapy, Computational Imaging Research Lab (CIR), Medical University of Vienna, Vienna, Austria
| | - Hui Ji
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | - Hao Liu
- Shanghai Jiaotong University, China
| | | | | | - Ying Peng
- School of Computer Science, Shaanxi Normal University, Xi'an 710119, China
| | - Juanying Xie
- School of Computer Science, Shaanxi Normal University, Xi'an 710119, China
| | - Huiquan Zhang
- School of Computer Science, Shaanxi Normal University, Xi'an 710119, China
| | - Guiming Dong
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Fu
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - ZunHyan Rieu
- Research Institute, NEUROPHET Inc., Seoul 06247, South Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc., Seoul 06247, South Korea
| | - Hyun Gi Kim
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul 06247, South Korea
| | - Davood Karimi
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ali Gholipour
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Helena R Torres
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga Guimarães, Portugal
| | - Bruno Oliveira
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga Guimarães, Portugal
| | - João L Vilaça
- 2Ai - School of Technology, IPCA, Barcelos, Portugal
| | - Yang Lin
- Department of Computer Science, Hong Kong University of Science and Technology, China
| | - Netanell Avisdris
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel; Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Israel
| | - Ori Ben-Zvi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Dafna Ben Bashat
- Sagol School of Neuroscience, Tel Aviv University, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Lucas Fidon
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, United Kingdom
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, United Kingdom
| | - Daniel Sobotka
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mireia Alenyà
- BCN-MedTech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Inmaculada Villanueva
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Oscar Camara
- BCN-MedTech, Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bella Specktor Fadida
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Israel
| | - Liao Weibin
- School of Computer Science, Beijing Institute of Technology, China
| | - Lv Yi
- School of Computer Science, Beijing Institute of Technology, China
| | - Li Xuesong
- School of Computer Science, Beijing Institute of Technology, China
| | - Moona Mazher
- Department of Computer Engineering and Mathematics, University Rovira i Virgili,Spain
| | | | - Domenec Puig
- Department of Computer Engineering and Mathematics, University Rovira i Virgili,Spain
| | - Hamza Kebiri
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM, Center for Biomedical Imaging, Lausanne, Switzerland
| | - Zelin Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Xinyi Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | | | - Yixuan Wu
- Zhejiang University, Hangzhou, China
| | | | - Yunzhi Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Li Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou, China
| | - Lana Vasung
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, United States; Department of Pediatrics, Harvard Medical School, United States
| | - Bjoern Menze
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Meritxell Bach Cuadra
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM, Center for Biomedical Imaging, Lausanne, Switzerland
| | - Andras Jakab
- Center for MR Research, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland; University Research Priority Project Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zürich, Zurich, Switzerland
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40
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Udine M, Loke YH, Goudar S, Donofrio MT, Truong U, Krishnan A. The current state and potential innovation of fetal cardiac MRI. Front Pediatr 2023; 11:1219091. [PMID: 37520049 PMCID: PMC10375913 DOI: 10.3389/fped.2023.1219091] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Fetal cardiac MRI is a rapidly evolving form of diagnostic testing with utility as a complementary imaging modality for the diagnosis of congenital heart disease and assessment of the fetal cardiovascular system. Previous technical limitations without cardiac gating for the fetal heart rate has been overcome with recent technology. There is potential utility of fetal electrocardiography for direct cardiac gating. In addition to anatomic assessment, innovative technology has allowed for assessment of blood flow, 3D datasets, and 4D flow, providing important insight into fetal cardiovascular physiology. Despite remaining technical barriers, with increased use of fCMR worldwide, it will become an important clinical tool to improve the prenatal care of fetuses with CHD.
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Affiliation(s)
- Michelle Udine
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States
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41
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Katz JA, Levy PT, Butler SC, Sadhwani A, Lakshminrusimha S, Morton SU, Newburger JW. Preterm congenital heart disease and neurodevelopment: the importance of looking beyond the initial hospitalization. J Perinatol 2023; 43:958-962. [PMID: 37179381 DOI: 10.1038/s41372-023-01687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Congenital heart disease (CHD) and prematurity are leading causes of infant mortality in the United States. Infants with CHD born prematurely are often described as facing "double jeopardy" with vulnerability from their underlying heart disease and from organ immaturity. They endure additional complications of developing in the extrauterine environment while healing from interventions for heart disease. While morbidity and mortality for neonates with CHD have declined over the past decade, preterm neonates with CHD remain at higher risk for adverse outcomes. Less is known about their neurodevelopmental and functional outcomes. In this perspective paper, we review the prevalence of preterm birth among infants with CHD, highlight the medical complexity of these infants, and emphasize the importance of exploring outcomes beyond survival. We focus on current knowledge regarding overlaps in the mechanisms of neurodevelopmental impairment associated with CHD and prematurity and discuss future directions for improving neurodevelopmental outcomes.
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Affiliation(s)
- Jenna A Katz
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Samantha C Butler
- Departments of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Anjali Sadhwani
- Departments of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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van Amerom JFP, Goolaub DS, Schrauben EM, Sun L, Macgowan CK, Seed M. Fetal cardiovascular blood flow MRI: techniques and applications. Br J Radiol 2023; 96:20211096. [PMID: 35687661 PMCID: PMC10321246 DOI: 10.1259/bjr.20211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Fetal cardiac MRI is challenging due to fetal and maternal movements as well as the need for a reliable cardiac gating signal and high spatiotemporal resolution. Ongoing research and recent technical developments to address these challenges show the potential of MRI as an adjunct to ultrasound for the assessment of the fetal heart and great vessels. MRI measurements of blood flow have enabled the assessment of normal fetal circulation as well as conditions with disrupted circulations, such as congenital heart disease, along with associated organ underdevelopment and hemodynamic instability. This review provides details of the techniques used in fetal cardiovascular blood flow MRI, including single slice and volumetric imaging sequences, post-processing and analysis, along with a summary of applications in human studies and animal models.
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Affiliation(s)
- Joshua FP van Amerom
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
| | | | - Eric M Schrauben
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Song JG, Sun C, Zhu M, Zhu JX, Zhang N, Wang GB, Zhao B. Regional changes in brain apparent diffusion coefficient in fetuses with complex congenital heart disease and normal pregnancy assessed using diffusion-weighted imaging. Front Neurol 2023; 14:1136633. [PMID: 37351264 PMCID: PMC10283352 DOI: 10.3389/fneur.2023.1136633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/19/2023] [Indexed: 06/24/2023] Open
Abstract
Objectives To explore changes in brain apparent diffusion coefficient (ADC) in normal fetuses and fetuses with complex congenital heart disease (CHD) during the second and early third trimesters. Methods This single-center prospective study was conducted from May 2019 through October 2021. We measured and compared the mean ADC values between 23 fetuses with CHD and 27 gestational age (GA)-matched controls using covariance analyses. ADC density plots and histograms were used to compare brain characteristics. False-discovery rates (FDR, α = 0.05) correction was used for multiple testing. Results The mean ADC in the frontal white matter, temporal white matter, parietal white matter, occipital white matter, cerebellar hemisphere, central area of the centrum semiovale, basal ganglia region, thalamus, and pons were not significantly different (all p > 0.05). Based on histogram analysis, there were no significant differences between the controls and fetuses with CHD after FDR correction. However, the ADC density plots showed significant heterogeneity between the controls and fetuses with CHD. Conclusion The mean ADC values and ADC histogram analysis did not differ between the CHD and normal groups. The ADC density plots may provide supplementary information and improve the sensitivity for detecting early brain changes in fetuses with CHD.
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Affiliation(s)
- Jia-Guang Song
- Department of Ultrasound, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Cong Sun
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Zhu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jin-Xia Zhu
- MR Collaboration, Healthcare Siemens Ltd., Beijing, China
| | - Nan Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guang-Bin Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bin Zhao
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
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Elgersma KM, Wolfson J, Fulkerson JA, Georgieff MK, Looman WS, Spatz DL, Shah KM, Uzark K, McKechnie AC. Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.26.23289126. [PMID: 37162951 PMCID: PMC10168482 DOI: 10.1101/2023.04.26.23289126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016-2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17-0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78-0.98, p=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative NEC (OR=0.28, 0.15-0.50, p<0.001) and sepsis (0.29, 0.13-0.65, p=0.003), and shorter S1P LOS (RR=0.75, 0.66-0.86, p<0.001). At S2P, infants with any HM (0.82, 0.69-0.97, p=0.018) and any BF (0.71, 0.57-0.89, p=0.003) experienced shorter LOS. Conclusions Infants with SV CHD in high HM and BF groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/BF in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader CHD populations, and should examine mechanisms (eg, HM components; microbiome) by which HM/BF benefits these infants. Clinical Perspective What is new?: This is the first large, multisite study examining the impact of human milk and breastfeeding on outcomes for infants with single ventricle congenital heart disease.All outcome estimates were better in high human milk and breastfeeding groups, with significantly lower odds of necrotizing enterocolitis, sepsis, and infection-related complications; and significantly shorter length of stay at both the neonatal stage 1 palliation and the subsequent stage 2 palliation.All estimates of all-cause mortality were substantially lower in human milk and breastfeeding groups, with clinically important estimates of 75%-100% lower odds of mortality in direct breastfeeding groups.What are the clinical implications?: There is a critical need for improved, condition-specific lactation support to address the low prevalence of human milk and breastfeeding for infants with single ventricle congenital heart disease.Increasing the dose and duration of human milk and direct breastfeeding has strong potential to substantially improve the health outcomes of these vulnerable infants.
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Affiliation(s)
| | - Julian Wolfson
- University of Minnesota School of Public Health, Division of Biostatistics
| | - Jayne A. Fulkerson
- University of Minnesota School of Nursing
- University of Minnesota School of Public Health, Division of Epidemiology
| | - Michael K. Georgieff
- University of Minnesota Medical School, Department of Pediatrics
- M Health Fairview University of Minnesota Masonic Children’s Hospital
| | | | - Diane L. Spatz
- University of Pennsylvania School of Nursing
- Children’s Hospital of Philadelphia
| | - Kavisha M. Shah
- University of Minnesota Medical School, Department of Pediatrics
- M Health Fairview University of Minnesota Masonic Children’s Hospital
| | - Karen Uzark
- University of Michigan Medical School, Division of Cardiac Surgery
- C. S. Mott Children's Hospital
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45
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Licht DJ, Jacobwitz M, Lynch JM, Ko T, Boorady T, Devarajan M, Heye KN, Mensah‐Brown K, Newland JJ, Schmidt A, Schwab P, Winters M, Nicolson SC, Montenegro LM, Fuller S, Mascio C, Gaynor JW, Yodh AG, Gebb J, Vossough A, Choi GH, Putt ME. Impaired Maternal-Fetal Environment and Risk for Preoperative Focal White Matter Injury in Neonates With Complex Congenital Heart Disease. J Am Heart Assoc 2023; 12:e025516. [PMID: 36974759 PMCID: PMC10122900 DOI: 10.1161/jaha.122.025516] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
Background Infants with congenital heart disease (CHD) are at risk for white matter injury (WMI) before neonatal heart surgery. Better knowledge of the causes of preoperative WMI may provide insights into interventions that improve neurodevelopmental outcomes in these patients. Methods and Results A prospective single-center study of preoperative WMI in neonates with CHD recorded data on primary cardiac diagnosis, maternal-fetal environment (MFE), delivery type, subject anthropometrics, and preoperative care. Total maturation score and WMI were assessed, and stepwise logistic regression modeling selected risk factors for WMI. Among subjects with severe CHD (n=183) who received a preoperative brain magnetic resonance imaging, WMI occurred in 40 (21.9%) patients. WMI prevalence (21.4%-22.1%) and mean volumes (119.7-160.4 mm3) were similar across CHD diagnoses. Stepwise logistic regression selected impaired MFE (odds ratio [OR], 2.85 [95% CI, 1.29-6.30]), male sex (OR, 2.27 [95% CI, 1.03-5.36]), and older age at surgery/magnetic resonance imaging (OR, 1.20 per day [95% CI, 1.03-1.41]) as risk factors for preoperative WMI and higher total maturation score values (OR, 0.65 per unit increase [95% CI, 0.43-0.95]) as protective. A quarter (24.6%; n=45) of subjects had ≥1 components of impaired MFE (gestational diabetes [n=12; 6.6%], gestational hypertension [n=11; 6.0%], preeclampsia [n=2; 1.1%], tobacco use [n=9; 4.9%], hypothyroidism [n=6; 3.3%], and other [n=16; 8.7%]). In a subset of 138 subjects, an exploratory analysis of additional MFE-related factors disclosed other potential risk factors for WMI. Conclusions This study is the first to identify impaired MFE as an important risk factor for preoperative WMI. Vulnerability to preoperative WMI was shared across CHD diagnoses.
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Affiliation(s)
- Daniel J. Licht
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Marin Jacobwitz
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Jennifer M. Lynch
- Department of Anesthesia and Critical Care, Division of Cardiac AnesthesiaThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Tiffany Ko
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Timothy Boorady
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Mahima Devarajan
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Kristina N. Heye
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Kobina Mensah‐Brown
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - John J. Newland
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Alexander Schmidt
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Peter Schwab
- Department of NeurologyThe University of PennsylvaniaPennsylvaniaPA
| | - Madeline Winters
- Department of Pediatrics, Division of NeurologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Susan C. Nicolson
- Department of Anesthesia and Critical Care, Division of Cardiac AnesthesiaThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Lisa M. Montenegro
- Department of Anesthesia and Critical Care, Division of Cardiac AnesthesiaThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Stephanie Fuller
- Department of Surgery, Division of Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Christopher Mascio
- Department of Surgery, Division of Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - J. William Gaynor
- Department of Surgery, Division of Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Arjun G. Yodh
- Department of Physics and AstronomyUniversity of PennsylvaniaPhiladelphiaPA
| | - Juliana Gebb
- Department of Surgery, Richard D. Wood Jr Center for Fetal Diagnosis & Treatment in the Division of Pediatric General, Thoracic and Fetal SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Arastoo Vossough
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Grace H. Choi
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPA
- CHOP/Penn Intellectual and Developmental Disabilities Research CenterPhiladelphiaPA
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPA
- CHOP/Penn Intellectual and Developmental Disabilities Research CenterPhiladelphiaPA
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Brossard-Racine M, Panigrahy A. Structural Brain Alterations and Their Associations With Function in Children, Adolescents, and Young Adults With Congenital Heart Disease. Can J Cardiol 2023; 39:123-132. [PMID: 36336305 DOI: 10.1016/j.cjca.2022.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Most neonates who receive surgery for complex congenital heart disease (CHD) will survive well into adulthood, however, many of them will face functional challenges at one point during their life as a consequence of their atypical neurodevelopment. Recent advances in neuroscience and the increasing accessibility of magnetic resonance imaging have allowed numerous studies to identify the nature and extent of the brain alterations that are particular to survivors with CHD. Nevertheless, and considering that the range of outcomes is broad in this population, the functional consequences of these brain differences is not always evident. In this review, we summarize the present state of knowledge regarding the structure-function relationships evaluated in children, adolescents, and young adults with CHD using structural magnetic resonance imaging. Overall smaller total and regional brain volume, as well as lower fractional anisotropy in numerous brain regions, were frequently associated with lower cognitive outcomes including executive functioning and memory in adolescents and young adults with CHD. However, we identify several gaps in knowledge including the limited number of prospective investigations involving neonatal imaging and follow-up during childhood or adolescence, as well as the need for studies that evaluate a broader range of functional outcomes and not only the cognitive abilities. Future interdisciplinary investigations using multimodal imaging techniques could help address these gaps.
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Affiliation(s)
- Marie Brossard-Racine
- Advances in Brain and Child Development Research Laboratory, Research Institute of McGill University Health Center - Child Heald and Human Development, and School of Physical and Occupational Therapy, Department of Pediatrics - Division of Neonatology and Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Ashok Panigrahy
- Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, and Clinical and Translational Imaging Research, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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47
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Peyvandi S, Rollins C. Fetal Brain Development in Congenital Heart Disease. Can J Cardiol 2023; 39:115-122. [PMID: 36174913 PMCID: PMC9905309 DOI: 10.1016/j.cjca.2022.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/18/2022] [Indexed: 02/07/2023] Open
Abstract
Neurodevelopmental impairments are the most common extracardiac morbidities among patients with complex congenital heart disease (CHD) across the lifespan. Robust clinical research in this area has revealed several cardiac, medical, and social factors that can contribute to neurodevelopmental outcome in the context of CHD. Studies using brain magnetic resonance imaging (MRI) have been instrumental in identifying quantitative and qualitative difference in brain structure and maturation in this patient population. Full-term newborns with complex CHD are known to have abnormal microstructural and metabolic brain development with patterns similar to those seen in premature infants at approximately 34 to 36 weeks' gestation. With the advent of fetal brain MRI, these brain abnormalities are now documented as they begin in utero, as early as the third trimester. Importantly, disturbed brain development in utero is now known to be independently associated with neurodevelopmental outcome in early childhood, making the prenatal period an important timeframe for potential interventions. Advances in fetal brain MRI provide a robust imaging tool to use in future neuroprotective clinical trials. The causes of abnormal fetal brain development are multifactorial and include cardiovascular physiology, genetic abnormalities, placental impairment, and other environmental and social factors. This review provides an overview of current knowledge of brain development in the context of CHD, common prenatal imaging tools to evaluate the developing fetal brain in CHD, and known risk factors contributing to brain immaturity.
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Affiliation(s)
- Shabnam Peyvandi
- University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA.
| | - Caitlin Rollins
- Boston Children's Hospital and Harvard University Departments of Neurology, Boston, Massachusetts, USA
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48
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Williamson BJ, Barnes-Davis ME, Vannest J, Anixt JS, Heydarian HC, Kuan L, Laue CS, Pratap J, Schapiro M, Tseng SY, Kadis DS. Altered white matter connectivity in children with congenital heart disease with single ventricle physiology. Sci Rep 2023; 13:1318. [PMID: 36693986 PMCID: PMC9873737 DOI: 10.1038/s41598-023-28634-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Children born with congenital heart disease (CHD) have seen a dramatic decrease in mortality thanks to surgical innovations. However, there are numerous risk factors associated with CHD that can disrupt neurodevelopment. Recent studies have found that psychological deficits and structural brain abnormalities persist into adulthood. The goal of the current study was to investigate white matter connectivity in early school-age children (6-11 years), born with complex cyanotic CHD (single ventricle physiology), who have undergone Fontan palliation, compared to a group of heart-healthy, typically developing controls (TPC). Additionally, we investigated associations between white matter tract connectivity and measures on a comprehensive neuropsychological battery within each group. Our results suggest CHD patients exhibit widespread decreases in white matter connectivity, and the extent of these decreases is related to performance in several cognitive domains. Analysis of network topology showed that hub distribution was more extensive and bilateral in the TPC group. Our results are consistent with previous studies suggesting perinatal ischemia leads to white matter lesions and delayed maturation.
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Affiliation(s)
| | - Maria E Barnes-Davis
- Department of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Julia S Anixt
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Haleh C Heydarian
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa Kuan
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cameron S Laue
- Department Psychology, Pacific University, Forest Grove, OR, USA
| | - Jayant Pratap
- Divisions of Cardiac Anesthesia and Cardiac Critical Care Medicine, Department of Anesthesia and Critical Care Medicine and Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Schapiro
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Darren S Kadis
- Neurosciences and Mental Health, Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Department of Physiology, University of Toronto, Toronto, ON, Canada.
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49
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Rizzo G, Pietrolucci ME, De Vito M, Pavjola M, Capponi A, Mappa I. Fetal brain biometry and cortical development in congenital heart disease: A prospective cross sectional study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:84-90. [PMID: 36069371 DOI: 10.1002/jcu.23308] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate brain biometry and cortical development by neurosonography in fetuses with congenital heart defect (CHD) and evaluate differences among different type of CHD. METHODS In a prospective cross sectional study singleton fetus with CHD were matched with controls and grouped into two categories according to the predicted severity of cerebral arterial oxygen deficit induced by the CHD: Group A mildly reduced or normal and Group B moderately to severely reduced. Neurosonography was done at 30-33 weeks to obtain measurements of corpus callosum (CC), cerebellar vermis (CV), Sylvian fissure (SF) insula, parieto-occipital fissure (POF), and calcarine sulci fissures (CSF). All the neurosonographic parameters were adjusted by head circumference (HC). RESULTS A total of 78 fetuses with CHD (group A 30; group B 48) and 80 matched controls form uncomplicated pregnancies were considered. CHD fetuses have significantly smaller CC, CV, SF, and POF and bigger insula when compared to control fetuses. These differences are more marked in group B fetuses. These differences remained significant after correction for HC values. CONCLUSION Fetuses with CHD have an impaired cortical development and these variations are more evident in those with a predicted lower oxygen delivery to the brain.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Marika De Vito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Maqina Pavjola
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Alessandra Capponi
- Department of Obstetrics and Gynecology, Ospedale San Giovanni Rome, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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50
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Moerdijk AS, Claessens NH, van Ooijen IM, van Ooij P, Alderliesten T, Grotenhuis HB, Benders MJNL, Bohte AE, Breur JMPJ, Charisopoulou D, Clur SA, Cornette JMJ, Fejzic Z, Franssen MTM, Frerich S, Geerdink LM, Go ATJI, Gommers S, Helbing WA, Hirsch A, Holtackers RJ, Klein WM, Krings GJ, Lamb HJ, Nijman M, Pajkrt E, Planken RN, Schrauben EM, Steenhuis TJ, ter Heide H, Vanagt WYR, van Beynum IM, van Gaalen MD, van Iperen GG, van Schuppen J, Willems TP, Witters I. Fetal MRI of the heart and brain in congenital heart disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:59-68. [PMID: 36343660 DOI: 10.1016/s2352-4642(22)00249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
Antenatal assessment of congenital heart disease and associated anomalies by ultrasound has improved perinatal care. Fetal cardiovascular MRI and fetal brain MRI are rapidly evolving for fetal diagnostic testing of congenital heart disease. We give an overview on the use of fetal cardiovascular MRI and fetal brain MRI in congenital heart disease, focusing on the current applications and diagnostic yield of structural and functional imaging during pregnancy. Fetal cardiovascular MRI in congenital heart disease is a promising supplementary imaging method to echocardiography for the diagnosis of antenatal congenital heart disease in weeks 30-40 of pregnancy. Concomitant fetal brain MRI is superior to brain ultrasound to show the complex relationship between fetal haemodynamics in congenital heart disease and brain development.
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Affiliation(s)
- Anouk S Moerdijk
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nathalie Hp Claessens
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge M van Ooijen
- Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pim van Ooij
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas Alderliesten
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
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