148 - Cerebral Abnormalities in Children with Congenital Heart Disease as Detected by Magnetic Resonance Imaging During Prenatal, Postnatal-Preoperative, and Postoperative Periods

Publication Number: 148.4491

Gautam Dagur, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Cynthia Ortinau, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Theresa I. Chin, The Warren Alpert Medical School of Brown University, Boston, MA, United States; Georgia Morris, The University of Queensland, Brisbane, Queensland, Australia; Jake Kleinmahon, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Roslyn Heights, NY, United States; Michelle Gurvitz, Boston Children's Hospital, Boston, MA, United States; Samudragupta Bora, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States

Background: Although mechanisms of neurodevelopmental impairments in children with congenital heart disease (CHD) are likely multifactorial, brain dysmaturation and brain injury likely underlie these impairments.

Objective: Determine overall prevalence of structural cerebral abnormalities identified on MRI in fetuses, infants, and children with CHD during prenatal, postnatal-preoperative, and postoperative periods. Furthermore, determine the prevalence stratified by CHD subtypes, i.e., transposition of great arteries (TGA), tetralogy of Fallot (ToF), hypoplastic left heart syndrome (HLHS), single ventricle heart disease (SVHD, including HLHS, as well as other univentricular classification), and mixed/unspecified cardiac lesions.

Design/Methods: This study is a systematic review and meta-analysis adhering to a preregistered protocol. A systematic search was conducted in five electronic databases, from inception to May 31, 2023. Studies published in English in peer-reviewed journals that met the following criteria were selected. 1) Samples comprised fetuses from 24 weeks gestation to birth or children from birth to 21 years, with 2) isolated (nonsyndromic) CHD with or without surgical intervention within the first year of life, and 3) reported structural cerebral abnormalities on MRI, during 4) prenatal, postnatal-preoperative, or postoperative period. Data were extracted independently by two authors and synthesized using random-effects modeling.

Results: The search yielded 6,686 citations, and 121 studies fulfilled inclusion criteria. Sample included 521, 1,746, and 2,128 fetuses and children with CHD for prenatal, postnatal-preoperative, and postoperative analyses, respectively, ensuring sample independence. The overall prevalence of cerebral abnormalities was 23.1%, 35.8%, and 50.0% for prenatal, postnatal-preoperative, and postoperative periods, respectively. Prevalence of prenatal abnormalities was 18.9% in TGA, 24.4% in ToF, 22.6% in HLHS, 25.1% in SVHD, and 19.7% in mixed/unspecified lesions. Prevalence of postnatal-preoperative abnormalities was 41.0% in TGA, 33.1% in HLHS, 32.6% in SVHD, and 37.0% in mixed/unspecified lesions. Prevalence of postoperative abnormalities was 40.3% in TGA, 71.2% in HLHS, 57.0% in SVHD, and 51.4% in mixed/unspecified cardiac lesions.

Conclusion(s): Structural cerebral abnormalities are prevalent in one-fifth of children with CHD, with evidence of an increase from prenatal to preoperative to postoperative periods. Different profiles emerged across CHD subtypes; TGA was the only diagnosis that did not show a higher rate of postoperative abnormalities relative to the preoperative period.

Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart for study selection.


Overall prevalence of structural cerebral abnormalities in fetuses and children with congenital heart disease during prenatal, postnatal-preoperative, and postoperative periods.
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