Structural Brain Alterations and Their Associations With Function in Children, Adolescents, and Young Adults With Congenital Heart Disease

Most neonates who receive surgery for complex congenital heart dis-ease (CHD) will survive well into adulthood, however, many of them will face functional challenges at one point during their life as a conse-quence of their atypical neurodevelopment. Recent advances in neuroscience and the increasing accessibility of magnetic resonance imaging have allowed numerous studies to identify the nature and extent of the brain alterations that are particular to survivors with CHD. Nevertheless, and considering that the range of outcomes is broad in this population, the functional consequences of these brain differences is not always evident. In this review, we summarize the present state of knowledge regarding the structure-function relationships evaluated in children, adolescents, and young adults with CHD using structural magnetic resonance imaging. Overall smaller total and regional brain volume, as well as lower fractional anisotropy in numerous brain re-gions, were frequently associated with lower cognitive outcomes including executive functioning and memory in adolescents and young adults with CHD. However, we identify several gaps in knowledge including the limited number of prospective investigations involving neonatal imaging and follow-up during childhood or adolescence, as well as the need for studies that evaluate a broader range of functional outcomes and not only the cognitive abilities. Future interdisciplinary investigations using multimodal imaging techniques could help address these gaps.

Automated summary

Most neonates with complex congenital heart disease who undergo surgery can survive to adulthood, but many may experience functional challenges due to atypical neurodevelopment. Advances in neuroscience and magnetic resonance imaging have allowed studies to identify brain alterations in these survivors. However, the functional consequences of these brain differences are not always clear, and more research is needed to explore a broader range of outcomes.