Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif.
Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2021 Sep;162(3):1007-1014.e1. doi: 10.1016/j.jtcvs.2020.09.096. Epub 2020 Oct 1.
To test the hypothesis that delayed brain development in fetuses with d-transposition of the great arteries or hypoplastic left heart syndrome heightens their postnatal susceptibility to acquired white matter injury.
This is a cohort study across 3 sites. Subjects underwent fetal (third trimester) and neonatal preoperative magnetic resonance imaging of the brain to measure total brain volume as a measure of brain maturity and the presence of acquired white matter injury after birth. White matter injury was categorized as no-mild or moderate-severe based on validated grading criteria. Comparisons were made between the injury groups.
A total of 63 subjects were enrolled (d-transposition of the great arteries: 37; hypoplastic left heart syndrome: 26). White matter injury was present in 32.4% (n = 12) of d-transposition of the great arteries and 34.6% (n = 8) of those with hypoplastic left heart syndrome. Overall total brain volume (taking into account fetal and neonatal scan) was significantly lower in those with postnatal moderate-severe white matter injury compared with no-mild white matter injury after adjusting for age at scan and site in d-transposition of the great arteries (coefficient: 14.8 mL, 95% confidence interval, -28.8 to -0.73, P = .04). The rate of change in total brain volume from fetal to postnatal life did not differ by injury group. In hypoplastic left heart syndrome, no association was noted between overall total brain volume and change in total brain volume with postnatal white matter injury.
Lower total brain volume beginning in late gestation is associated with increased risk of postnatal moderate-severe white matter injury in d-transposition of the great arteries but not hypoplastic left heart syndrome. Rate of brain growth was not a risk factor for white matter injury. The underlying fetal and perinatal physiology has different implications for postnatal risk of white matter injury.
检验胎儿右位主动脉弓或左心发育不全综合征时，脑发育迟缓会增加其出生后获得性脑白质损伤易感性的假说。
这是一个跨越 3 个地点的队列研究。研究对象在胎儿（妊娠晚期）和新生儿术前接受脑磁共振成像，以测量总脑容量作为脑成熟度的指标，并在出生后测量获得性脑白质损伤。根据验证后的分级标准，将脑白质损伤分为无-轻度或中重度。对损伤组进行比较。
共纳入 63 例受试者（右位主动脉弓：37 例；左心发育不全综合征：26 例）。右位主动脉弓组中，32.4%（n=12）存在脑白质损伤，左心发育不全综合征组中，34.6%（n=8）存在脑白质损伤。调整右位主动脉弓的扫描年龄和地点后，与无-轻度脑白质损伤相比，中重度脑白质损伤患者的总脑容量（考虑胎儿和新生儿扫描）整体明显较低（系数：14.8ml，95%置信区间，-28.8 至-0.73，P=0.04）。从胎儿到出生后生活的总脑容量变化率在损伤组之间没有差异。在左心发育不全综合征中，总脑容量与出生后脑白质损伤的总脑容量变化之间没有关联。
妊娠晚期总脑容量降低与右位主动脉弓患者出生后脑白质损伤中重度风险增加相关，但与左心发育不全综合征无关。脑生长速度不是脑白质损伤的危险因素。潜在的胎儿和围产期生理状况对出生后脑白质损伤的风险有不同的影响。
