Congenital heart disease (CHD) is a birth defect affecting the structure and function of the heart. Advances in medical care have significantly improved survival rates for children with CHD, but a growing concern is the potential impact of surgery on their brain development. CHDs can impact a baby’s heart’s function and structure. They have the potential to influence how blood flows through the heart and out to the rest of the body. CHDs can range from minor (a tiny hole in the heart) to severe (missing or poorly formed heart components). A critical CHD (also known as a critical congenital heart defect) affects around one in every four newborns born with a heart problem. In the first year of life, babies with serious CHD require surgery or other interventions.
Key findings:
- Brain injury is common in infants with complex CHD who undergo surgery, with 57% showing new or worsened injury on MRI scans.
- Children with evidence of new stroke on postoperative MRI are more likely to have poor neurodevelopmental outcomes in early childhood.
- High levels of lactic acid after surgery are also associated with poor neurodevelopmental outcomes.
Potential causes of brain injury in CHD:
- Preoperative factors: Congestive heart failure, low blood pressure, and cyanosis (blue skin) can decrease blood flow to the brain.
- Perioperative factors: Cardiopulmonary bypass, deep hypothermic circulatory arrest, and low blood pressure during surgery can deprive the brain of oxygen and nutrients.
- Postoperative factors: Complications such as stroke, seizures, and bleeding can further damage the brain.
Neurodevelopmental outcomes associated with CHD:
- Mild cognitive impairment: Difficulty with learning, memory, and problem-solving.
- Motor dysfunction: Delays in reaching developmental milestones such as walking and talking.
- Visual-spatial and visual-motor difficulties: Challenges with coordination and spatial awareness.
- Attention and academic difficulties: Difficulty focusing and completing tasks, learning disabilities.