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Open Access Publications from the University of California

Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2016)

Purpose: This research study sought to explore whether fetal total brain volume (TBV) determined by using conventional fetal MR imaging is associated with postnatal preoperative brain injury in neonates with critical congenital heart disease (CHD). A secondary aim was to investigate the trajectory of brain growth from the fetal to neonatal time period in this same patient population.

Methods: Twenty subjects had complex CHD diagnosed in utero and required postnatal neonatal surgery at University of California, San Francisco (UCSF) from 2010-2016. Fetal and neonatal MRI scans from 12 of the 20 eligible subjects were processed and analyzed in this study. These scans and clinical data are a part of an ongoing study to investigate the effects of CHD on brain injury and neurodevelopmental outcome at UCSF.

Results: This study revealed a strong linear relationship between fetal TBV and gestational age (p=0.0012). Subjects with preoperative brain injury tended to have a smaller mean fetal TBV (187.8 cm^3, 95%CI: 156.9-218.7) as compared to those without preoperative brain injury (225.2 cm^3, 95%CI: 189.8-260.6; p=0.165). There was also a trend towards decreasing TBV with a higher brain injury severity (BIS) score (BIS 0, TBV 225.1 ± 38.3 cm^3; BIS 1, TBV 210.9 cm^3; BIS 2, TBV 199.2 cm^3; BIS 3, TBV 176.4 ± 26.6 cm^3; p=0.06). The rate of increase in TBV from the fetal to neonatal time period was similar in those with and without preoperative brain injury (p=0.33).

Conclusions: These preliminary findings suggest a potential relationship between in-utero brain growth and the risk of neonatal preoperative brain injury in patients with critical CHD. A larger sample size will be analyzed to further assess this relationship.

    Cover page: Fetal Brain Measurements May Predict Neonatal Brain Injury in Patients with Critical Congenital Heart Disease
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2018)

    Objective

    To assess the trajectory of perioperative brain growth in relationship to cardiac diagnosis and acquired brain injuries.

    Methods

    This was a cohort study of term neonates with hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (d-TGA). Subjects underwent magnetic resonance imaging of the brain pre- and postoperatively to determine the severity of brain injury and total and regional brain volumes by the use of automated morphometry. Comparisons were made by cardiac lesion and injury status.

    Results

    A total of 79 subjects were included (49, d-TGA; 30, HLHS). Subjects with HLHS had more postoperative brain injury (55.6% vs 30.4%, P = .03) and more severe brain injury (moderate-to-severe white matter [WM] injury, P = .01). Total and regional perioperative brain growth was not different by brain injury status (either pre- or postoperative). However, subjects with moderate-to-severe WM injury had a slower rate of brain growth in WM and gray matter compared with those with no injury. Subjects with HLHS had a slower rate of growth globally and in WM and deep gray matter as compared with d-TGA (total brain volume: 12 cm3/wk vs 7 cm3; WM: 2.1 cm3/wk vs 0.6 cm3; deep gray matter: 1.5 cm3/wk vs 0.7 cm3; P < .001), after we adjusted for gestational age at scan and the presence of brain injury. This difference remained after excluding subjects with moderate-to-severe WM injury.

    Conclusions

    Neonates with HLHS have a slower rate of global and regional brain growth compared with d-TGA, likely related to inherent physiologic differences postoperatively. These findings demonstrate the complex interplay between cardiac lesion, brain injury, and brain growth.
      Cover page: The association between cardiac physiology, acquired brain injury, and postnatal brain growth in critical congenital heart disease
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