Advances in Brain & Child Development (ABCD) Research Laboratory Research Institute of the McGill University Health Centre Montreal Quebec Canada.
Department of Neurology & Neurosurgery, Faculty of Medicine & Health Sciences McGill University Quebec Montreal Canada.
J Am Heart Assoc. 2023 Jun 20;12(12):e028378. doi: 10.1161/JAHA.122.028378. Epub 2023 Jun 10.
Background Lower cerebral blood flow (CBF) has previously been documented preoperatively in neonates with congenital heart disease (CHD). However, it remains unclear if these CBF deficits persist over the life span of CHD survivors following heart surgery. When exploring this question, it is critical to consider the sex differences in CBF that emerge during adolescence. Therefore, this study aimed to compare global and regional CBF between postpubertal youth with CHD and healthy peers and examine if such alterations are related to sex. Methods and Results Youth aged 16 to 24 years who underwent open heart surgery for complex CHD during infancy and age- and sex-matched controls completed brain magnetic resonance imaging, including T1-weighted and pseudo-continuous arterial spin labeling acquisitions. Global gray matter CBF and regional CBF in 9 bilateral gray matter regions were quantified for each participant. Compared with female controls (N=27), female participants with CHD (N=25) presented with lower global and regional CBF. In contrast, there were no differences in CBF between male controls (N=18) and males with CHD (N=17). Concurrently, female controls had higher global and regional CBF compared with male controls, with no differences in CBF between female and male participants with CHD. CBF was lower in individuals with a Fontan circulation. Conclusions This study provides evidence of altered CBF in postpubertal female participants with CHD despite undergoing surgical intervention during infancy. Alterations to CBF could have implications for later cognitive decline, neurodegeneration, and cerebrovascular disease in women with CHD.
背景 先前有研究记录了患有先天性心脏病（CHD）的新生儿术前大脑血流（CBF）降低。然而，心脏手术后 CHD 幸存者的 CBF 缺陷是否会持续存在仍不清楚。在探讨这个问题时，必须考虑到青春期出现的 CBF 性别差异。因此，本研究旨在比较 CHD 青少年和健康同龄人之间的全脑和局部 CBF，并检查这些变化是否与性别有关。
方法和结果 16 至 24 岁的青少年，他们在婴儿期接受过心脏直视手术治疗复杂的 CHD，并与年龄和性别匹配的对照组一起完成了脑部磁共振成像，包括 T1 加权和伪连续动脉自旋标记采集。为每位参与者量化了全局灰质 CBF 和 9 个双侧灰质区域的局部 CBF。与女性对照组（N=27）相比，患有 CHD 的女性参与者（N=25）的全脑和局部 CBF 较低。相比之下，男性对照组（N=18）和男性 CHD 参与者（N=17）之间的 CBF 没有差异。同时，女性对照组的全脑和局部 CBF 高于男性对照组，而 CHD 女性和男性参与者之间的 CBF 没有差异。Fontan 循环的个体 CBF 较低。
结论 尽管在婴儿期接受了手术干预，但本研究为青春期 CHD 女性参与者 CBF 改变提供了证据。CBF 的改变可能对 CHD 女性的认知能力下降、神经退行性变和脑血管疾病有影响。
