Department of Pediatrics, University of Toyama, Toyama, Japan.
J Thorac Cardiovasc Surg. 2012 May;143(5):1077-85. doi: 10.1016/j.jtcvs.2011.08.042. Epub 2011 Oct 2.
We performed a prospective longitudinal study of the neuroanatomic and developmental changes in infants with transposition of the great arteries (TGA) or single-ventricle (SV) physiology to identify variables in anatomic development of the brain associated with functional impairment.
Thirty-three infants with congenital heart defects, 23 with SV and 10 with TGA, were studied at around 1 year old (time 1) and 3 years old (time 2) by magnetic resonance imaging of the brain. Neurodevelomental assessment was performed at the same time.
The whole and frontal lobe volumes were significantly reduced in both groups at time 1 compared with normal control subjects (P < .01). However, by time 2 whole and frontal brain volumes were normal in the TGA group but remained significantly smaller (P < .01) in the SV group. In agreement with these findings, the mental development index (MDI) was lower (P < .05) at time 1 in both groups but improved to normal levels at time 2 in the TGA group. In the SV group, both MDI and the psychomotor development index (PDI) were significantly decreased at both time 1 and time 2 (P < .01). These patients continued to experience hypoxia, and multivariate analysis revealed that functional oxygen saturation was significantly associated with PDI. Further, the PDI score correlated with whole and regional brain volumes (P < .05).
Neuroanatomic and developmental outcomes improve progressively in infants with TGA, unlike those with SV physiology. Impaired cerebral circulation and hypoxia may have significant effects on brain growth and development in infants with critical congenital heart disease.
我们对大动脉转位（TGA）或单心室（SV）生理患儿进行了前瞻性纵向研究，以研究大脑解剖发育的变量与功能障碍相关，这些变量存在于解剖学发育中。
33 名患有先天性心脏病的婴儿，23 名患有 SV，10 名患有 TGA，在大约 1 岁（时间 1）和 3 岁（时间 2）时通过脑部磁共振成像进行研究。同时进行神经发育评估。
与正常对照组相比，两组在时间 1 时全脑和额叶体积均明显减小（P <.01）。然而，在 TGA 组，到时间 2 时全脑和额叶脑体积均正常，但 SV 组仍明显较小（P <.01）。与这些发现一致，在两组中，智力发育指数（MDI）在时间 1 时均较低（P <.05），但在 TGA 组中在时间 2 时提高到正常水平。在 SV 组中，MDI 和精神运动发育指数（PDI）在时间 1 和时间 2 均明显降低（P <.01）。这些患者继续经历缺氧，多变量分析显示功能氧饱和度与 PDI 显著相关。此外，PDI 评分与全脑和区域脑体积相关（P <.05）。
与 SV 生理患儿不同，TGA 患儿的神经解剖和发育结果逐渐改善。脑循环和缺氧受损可能对患有严重先天性心脏病的婴儿的大脑生长和发育产生重大影响。
