Commentary: Once again—the heart and the brain

Central MessageLow total brain volume is a predictor for preoperative white matter injury in dextro-transposition of the great arteries but not hypoplastic left heart syndrome.See Article page 1007. Low syndrome. See Nowadays vast majority children born with congenital disease (CHD) will reach adulthood,1Marelli A.J. Ionescu-Ittu R. Mackie A.S. Guo L. Dendukuri N. Kaouache M. Lifetime prevalence general population from 2000 to 2010.Circulation. 2014; 130: 749-756Crossref PubMed Scopus (727) Google Scholar CHD are still at increased risk developmental disorders, disabilities, or development delay.2Mussatto K.A. Hoffmann R.G. Hoffman G.M. Tweddell J.S. Bear Cao Y. et al.Risk and delay young disease.Pediatrics. 133: e570-e577Crossref (156) Although life expectancy steadily rising even cases complex CHD, efforts ensure good long-term neurologic outcome patients warranted. Because it has been shown that may already be present preoperatively, prenatal immaturity increases postoperative injury,3Limperopoulos C. Majnemer A. Shevell M.I. Rosenblatt B. Rohlicek Tchervenkov Neurodevelopmental status newborns infants defects before after open surgery.J Pediatr. 2000; 137: 638-645Abstract Full Text PDF (223) highly relevant investigate connection potential factors this group. In issue Journal, Peyvandi colleagues4Peyvandi S. Lim J.M. Marini D. Xu Reddy V.M. Barkovich al.Fetal growth postnatal critical disease.J Thorac Cardiovasc Surg. 2021; 162: 1007-1014.e1Abstract (15) report their longitudinal multicenter study demonstrating association between lower (TBV) elevated acquired neonatal (WMI) (d-TGA). For purpose, cohort comprised 63 patients, including 37 d-TGA 26 syndrome (HLHS) fetal (third trimester) as well magnetic resonance imaging (MRI). TBV WMI were scored on MRI. Repeated-measures analysis group, adjusted both postmenstrual age MRI site, revealed overall was moderate severe each week compared those none/mild WMI. The increase did differ by Interestingly, HLHS, no found injury. authors point out pathophysiological background these findings possible underlying causes CHD. Starting midgestation, oligodendrocytes originate subventricular zone, migrate, expand, speed myelination, resulting new connections neurons.5Morton P.D. Ishibashi Jonas R.A. abnormalities disease: insights into altered maturation.Circ Res. 2017; 120: 960-977Crossref (104) period, develops smooth mass toward its fully grown form gyri sulci. This differentiated process susceptible negative influences, such malnutrition hypoxemia, often prevalent fetuses As result, could cortical gyrification reduced, 25% microcephalic birth.6Clouchoux du Plessis Bouyssi-Kobar Tworetzky W. McElhinney D.B. Brown D.W. al.Delayed disease.Cereb Cortex. 2013; 23: 2932-2943Crossref (219) Scholar,7Miller S.P. McQuillen P.S. Hamrick Glidden D.V. Charlton al.Abnormal disease.N Engl J Med. 2007; 357: 1928-1938Crossref (678) strongly associated injuries8Hinton R.B. Andelfinger G. Sekar P. Hinton A.C. Gendron R.L. Michelfelder E.C. al.Prenatal head syndrome.Pediatr 2008; 64: 364-369Crossref (107) neurodevelopmental abnormalities, authors' strengthen hypothesis. Nonetheless, do explain why predictive higher group HLHS speculate though nutrient oxygen delivery believed similar d-TGA, physiology during transition circulation have major impact result an cerebral hypoxia perinatal period. thesis supported increasing number studies pointing earlier repair better health. colleagues9Lim Porayette Chau V. Au-Young S.H. Saini al.Associations arterial switch operation, growth, transposition arteries.Circulation. 2019; 139: 2728-2738Crossref (49) recently contributed topic showing surgery beyond 2 weeks impaired slower language development. highlights once more among many injury, establishing normal rapidly developing earlier, preponed might effective strategy reduce Considering colleagues, low especially benefit strategy. Further needed origin predictors injuries strategies prevent them. These add important piece puzzle myriad delays CHD.10Petit C.J. Rome J.J. Wernovsky Mason S.E. Shera D.M. Nicolson S.C. al.Preoperative oxygenation time surgery, balloon atrial septostomy.Circulation. 2009; 119: 709-716Crossref (211) Scholar, 11Dimitropoulos Sethi Moosa al.Brain disease.Neurology. 81: 241-248Crossref (178) 12Goff D.A. Tang Lavin N.A. Durning S.M. periventricular leukomalacia term neonates patient related.J 147: 1312-1318Abstract can used fetus accordingly, adapted management high-risk planned advance. We congratulate colleagues excellent work. Fetal diseaseThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 3PreviewTo test hypothesis delayed d-transposition heightens susceptibility Full-Text