Children with Congenital Heart Diseases Exhibit Altered Deep Gray Matter Structures

Nils D Forkert; Sarah J MacEachern; Allison K Duh; Peter Moon; Sarah Lee; Kristen W Yeom

doi:10.1007/s00062-024-01417-z

Children with Congenital Heart Diseases Exhibit Altered Deep Gray Matter Structures

Clin Neuroradiol. 2024 May 14. doi: 10.1007/s00062-024-01417-z. Online ahead of print.

Authors

Nils D Forkert^{1

2

3

4}, Sarah J MacEachern^{5

6

7}, Allison K Duh⁸, Peter Moon⁸, Sarah Lee⁹, Kristen W Yeom¹⁰

Affiliations

¹ Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, T2N 4N1, Calgary, AB, Canada. nils.forkert@ucalgary.ca.
² Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. nils.forkert@ucalgary.ca.
³ Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. nils.forkert@ucalgary.ca.
⁴ Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. nils.forkert@ucalgary.ca.
⁵ Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷ Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁸ Stanford University School of Medicine, Stanford, CA, USA.
⁹ Department of Neurology, Divisions of Stroke and Child Neurology, Stanford School of Medicine, Palo Alto, CA, USA.
¹⁰ Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA.

PMID: 38743101
DOI: 10.1007/s00062-024-01417-z

Abstract

Background and objectives: Children with congenital heart diseases (CHDs) have an increased risk of developing neurologic deficits, even in the absence of apparent brain pathology. The aim of this work was to compare quantitative macro- and microstructural properties of subcortical gray matter structures of pediatric CHD patients with normal appearing brain magnetic resonance imaging to healthy controls.

Methods: We retrospectively reviewed children with coarctation of the aorta (COA) and hypoplastic left heart syndrome (HLHS) admitted to our hospital. We identified 24 pediatric CHD patients (17 COA, 7 HLHS) with normal-appearing brain MRI. Using an atlas-based approach, the volume and apparent diffusion coefficient (ADC) were determined for the thalamus, caudate, putamen, pallidum, hippocampus, amygdala, nucleus accumbens, cerebral white matter, cerebral cortex, and brainstem. Multivariate statistics were used to compare the extracted values to reference values from 100 typically developing children without any known cardiac or neurological diseases.

Results: Multivariate analysis of covariance using the regional ADC and volume values as dependent variables and age and sex as co-variates revealed a significant difference between pediatric CHD patients and healthy controls (p < 0.001). Post-hoc comparisons demonstrated significantly reduced brain volumes in most subcortical brain regions investigated and elevated ADC values in the thalamus for children with CHD. No significant differences were found comparing children with COA and HLHS.

Conclusions: Despite normal appearing brain MRI, children with CHD exhibit wide-spread macro-structural and regional micro-structural differences of subcortical brain structures compared to healthy controls, which could negatively impact neurodevelopment, leading to neurological deficits in childhood and beyond.

Keywords: Brain; Children; Congenital heart diseases; Diffusion-weighted MRI; Magnetic resonance imaging.

Grants and funding

NA/Canada Excellence Research Chairs, Government of Canada