Brain maturation is delayed in infants with complex congenital heart defects.
Brain maturation is delayed in infants with complex congenital heart defects.
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DOI：
10.1016/j.jtcvs.2008.10.025
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发表时间：
2009-03
影响因子：
6
通讯作者：
Vossough, Arastoo
中科院分区：
文献类型：
--
作者：
Licht, Daniel J.;Shera, David M.;Clancy, Robert R.;Wernovsky, Gil;Montenegro, Lisa M.;Nicolson, Susan C.;Zimmerman, Robert A.;Spray, Thomas L.;Gaynor, J. William;Vossough, Arastoo
在患有严重先天性心脏病的婴儿群体中观察到头围较小和脑室周围白质软化形式的白质损伤。这项研究检验了先天性心脏病会延迟子宫结构性大脑发育的假设。通过术前脑磁共振成像对患有左心发育不全综合征或大动脉转位的足月婴儿进行前瞻性评估。排除具有脑发育异常独立危险因素（休克、终末器官损伤或宫内生长迟缓）的患者。结果测量包括头围和磁共振成像的总成熟评分。总成熟度评分是先前经过验证的半定量解剖评分系统，用于评估全脑成熟度。总成熟度评分评估成熟度的 4 个参数：(1) 髓鞘形成，(2) 皮质内折叠，(3) 神经胶质细胞迁移带的退化，以及 (4) 生发基质组织的存在。研究队列包括 29 名患有左心发育不全综合征的新生儿和 13 名患有大动脉转位的新生儿，平均孕龄为 38.9 ± 1.1 周。平均头围比正常值低 1 个标准差。该队列的平均总成熟得分为 10.15 ± 0.94，显着低于报告的无先天性心脏缺陷婴儿的规范数据，相当于大脑结构发育延迟 1 个月。在手术前，患有左心发育不全综合征和大动脉转位的足月儿的大脑比预期更小，结构也更不成熟。这种大脑发育迟缓可能会增加术前、术中和术后对脑室周围白质软化症的易感性。
Small head circumferences and white matter injury in the form of periventricular leukomalacia have been observed in populations of infants with severe forms of congenital heart defects. This study tests the hypothesis that congenital heart defects delay in utero structural brain development. Full-term infants with hypoplastic left heart syndrome or transposition of the great arteries were prospectively evaluated with preoperative brain magnetic resonance imaging. Patients with independent risk factors for abnormal brain development (shock, end-organ injury, or intrauterine growth retardation) were excluded. Outcome measures included head circumferences and the total maturation score on magnetic resonance imaging. Total maturation score is a previously validated semiquantitative anatomic scoring system used to assess whole brain maturity. The total maturation score evaluates 4 parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. The study cohort included 29 neonates with hypoplastic left heart syndrome and 13 neonates with transposition of the great arteries at a mean gestational age of 38.9 ± 1.1 weeks. Mean head circumference was 1 standard deviation below normal. The mean total maturation score for the cohort was 10.15 ± 0.94, significantly lower than reported normative data in infants without congenital heart defects, corresponding to a delay of 1 month in structural brain development. Before surgery, term infants with hypoplastic left heart syndrome and transposition of the great arteries have brains that are smaller and structurally less mature than expected. This delay in brain development may foster susceptibility to periventricular leukomalacia in the preoperative, intraoperative, and postoperative periods.
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DOI：
10.1016/j.jtcvs.2003.09.053
发表时间：
2004-03-01
影响因子：
6
作者：
Galli, KK;Zimmerman, RA;Gaynor, JW
通讯作者：
Gaynor, JW
影响因子：
4.6
作者：
Hoevels-Guerich, Hedwig H.;Konrad, Kerstin;Seghaye, Marie-Christine
通讯作者：
Seghaye, Marie-Christine
影响因子：
2.8
作者：
Ramenghi, Luca A.;Fumagalli, Monica;Mosca, Fabio
通讯作者：
Mosca, Fabio
影响因子：
6
作者：
Bellinger, DC;Wypij, D;Newburger, JW
通讯作者：
Newburger, JW
影响因子：
1.6
作者：
Donofrio, MT;Bremer, YA;Kleinman, CS
通讯作者：
Kleinman, CS