Diagnostic Imaging and Radiology.
Cereb Cortex. 2013 Dec;23(12):2932-43. doi: 10.1093/cercor/bhs281. Epub 2012 Sep 12.
Neurologic impairment is a major complication of complex congenital heart disease (CHD). A growing body of evidence suggests that neurologic dysfunction may be present in a significant proportion of this high-risk population in the early newborn period prior to surgical interventions. We recently provided the first evidence that brain growth impairment in fetuses with complex CHD has its origins in utero. Here, we extend these observations by characterizing global and regional brain development in fetuses with hypoplastic left heart syndrome (HLHS), one of the most severe forms of CHD. Using advanced magnetic resonance imaging techniques, we compared in vivo brain growth in 18 fetuses with HLHS and 30 control fetuses from 25.4-37.0 weeks of gestation. Our findings demonstrate a progressive third trimester fall-off in cortical gray and white matter volumes (P < 0.001), and subcortical gray matter (P < 0.05) in fetuses with HLHS. Significant delays in cortical gyrification were also evident in HLHS fetuses (P < 0.001). In the HLHS fetus, local cortical folding delays were detected as early as 25 weeks in the frontal, parietal, calcarine, temporal, and collateral regions and appear to precede volumetric brain growth disturbances, which may be an early marker of elevated risk for third trimester brain growth failure.
神经功能障碍是复杂先天性心脏病（CHD）的主要并发症。越来越多的证据表明，在接受手术干预之前的新生儿早期，高危人群中相当一部分可能存在神经功能障碍。我们最近首次提供了证据，表明复杂 CHD 胎儿的脑生长受损起源于宫内。在这里，我们通过对左心发育不全综合征（HLHS）胎儿的全脑和局部脑发育进行特征描述，扩展了这些观察结果。HLHS 是 CHD 最严重的形式之一。我们使用先进的磁共振成像技术，比较了 18 例 HLHS 胎儿和 30 例 25.4-37.0 孕周的对照胎儿的体内脑生长情况。我们的研究结果表明，HLHS 胎儿在妊娠晚期第三季度皮质灰质和白质体积（P < 0.001）以及皮质下灰质（P < 0.05）呈渐进性下降。HLHS 胎儿的皮质回纹也明显延迟（P < 0.001）。在 HLHS 胎儿中，局部皮质折叠延迟早在 25 周时就可以在前额、顶叶、距状裂、颞叶和侧裂区域检测到，并且似乎先于脑体积生长障碍，这可能是妊娠晚期脑生长失败风险升高的早期标志物。
