Brigham and Women's Hospital Boston

Dr. Cynthia Ortinau, Primary Investigator
Research Project: Understanding Fetal Brain Development in Critical Congenital Heart Disease
Amount funded $32,948 (Year 1) and $21,414 (Year 2)

Over recent years, survival has dramatically improved for forms of congenital heart disease (CHD) that require surgery or catheter procedures during the first year of life. With this improved survival, it has become increasingly recognized that these children have a high prevalence of neurodevelopmental impairments that persist into adolescence. These encompass a variety of domains and include motor deficits, impaired cognition, behavioral problems, and challenges with language, visual-spatial kills, and executive functioning. The underlying brain abnormalities that contribute to these outcomes have not been fully defined. However, brain magnetic resonance imaging (MRI) studies have provided some insight. A common finding on brain MRI is altered brain development, which is present before cardiac surgery and even begins during pregnancy. A key part of brain development during the third trimester of pregnancy is the development of the cortex, the outer region of the brain. Abnormalities in cortical development have been demonstrated in preterm infants, a population that has similar neurodevelopmental impairments to children with critical CHD (CCHD).

Data suggests that altered fetal brain development may play a key role in the subsequent neurodevelopmental outcomes of children with CCHD. The timing and sequence of fetal cortical alterations and white and gray matter deficits have not been explained. Additionally, the effect of other CCHD diagnoses on these fetal cortical impairments has not been described. Before we can begin targeted fetal intervention studies to reduce the incidence of neurodevelopmental impairments, we need to understand the nature and timing of neurological deficits in fetuses with CCHD and determine which patients may benefit from early neuroprotection. To address this urgent need, we are proposing to investigate fetal brain development in CCHD using state-of-the-art MRI techniques to establish the timing and sequence of cortical, white matter, and gray matter deficits and to alterations in brain development.