Neurodevelopmental Abnormalities and Congenital Heart Disease: Insights Into Altered Brain Maturation.
Neurodevelopmental Abnormalities and Congenital Heart Disease: Insights Into Altered Brain Maturation.
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DOI：
10.1161/circresaha.116.309048
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发表时间：
2017-03-17
影响因子：
20.1
通讯作者：
Jonas RA
中科院分区：
文献类型：
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作者：
Morton PD;Ishibashi N;Jonas RA
在过去的二十年中，很明显，先天性心脏病（CHD）患者有终身神经功能缺损的风险。与CHD相关的神经发育异常的多因素风险因素已被确定;然而，潜在的病因仍然在很大程度上未知，解决这个问题的努力只是最近才开始。已经有一个戏剧性的转变，重点从新获得的脑损伤与矫正和姑息性心脏手术，产前和术前因素控制改变脑成熟的冠心病。在这篇综述中，我们描述了发育的关键时间窗口，在此期间，未成熟的大脑容易受到伤害。特别强调细胞事件的动态性质，以及CHD如何对适当的认知和运动功能所需的细胞单位和网络产生不利影响。此外，我们描述了目前的知识差距，并提供了关于可以做些什么来提高我们对CHD神经功能缺损的理解的观点。最终，一个多学科的方法将是必不可少的，以防止或改善不利的神经发育结果的个人生存冠心病。
In the past two decades it has become evident that individuals born with congenital heart disease (CHD) are at risk of developing life-long neurological deficits. Multifactorial risk factors contributing to neurodevelopmental abnormalities associated with CHD have been identified; however the underlying etiologies remain largely unknown and efforts to address this issue have only recently begun. There has been a dramatic shift in focus from newly acquired brain injuries associated with corrective and palliative heart surgery to antenatal and preoperative factors governing altered brain maturation in CHD. In this review, we describe key time windows of development during which the immature brain is vulnerable to injury. Special emphasis is placed on the dynamic nature of cellular events and how CHD may adversely impact the cellular units and networks necessary for proper cognitive and motor function. In addition, we describe current gaps in knowledge and offer perspectives about what can be done to improve our understanding of neurological deficits in CHD. Ultimately, a multidisciplinary approach will be essential in order to prevent or improve adverse neurodevelopmental outcomes in individuals surviving CHD.