Cerebral MRI Findings and Neurodevelopmental Outcome in Patients Operated for Congenital Heart Disease – From the Neonate to the Adolescent

Objectives: Patients with congenital heart disease (CHD) are at risk for neurodevelopmental impairments. We studied short- and long-term effect of CHD on brain development and function in neonates and adolescents.

Methods: Cerebral pre- and postoperative MRI of 32 term-born (mean age: 6.8 resp. 26.8 days) and postoperative MRI of 48 adolescents CHD patients (13.8 years) were analyzed (compared with age-matched controls) and correlated with neurodevelopmental outcome.

Results: Between pre- and postoperative MRI in the neonatal population, patients showed significant brain growth per day, in the cortical gray matter (0.25%), cerebellum (0.20%), deep gray matter structures (0.15%), white matter (0.05%), and total brain volume (0.14%) (all, p < 0.05). The size of all brain structures was significantly reduced postoperatively, in deep gray matter structures (13.8%), cortical gray (12.1%) white matter (11.8%), and total brain volumes (11.3%) (all, p < 0.05). In the adolescent population, we found lower total brain volume, white matter, and gray matter volumes (p < 0.05). Regional brain volume reduction ranged from 5.3% (cortical gray matter) to 11% (corpus callosum), more pronounced for cyanotic CHD. Volume reduction of gray and white matter correlated significantly with cognitive, motor, and executive function (all p < 0.05).

Conclusions: In neonates with CHD, significant differences of white and deep gray matter volumes were found postoperatively. Adolescents with CHD show permanent brain volume loss, correlating with poorer neurodevelopmental outcome.