Delayed Cortical Development in Fetuses with Complex Congenital Heart Disease

Neurologic impairment is a major complication of complex congeni-tal heart disease (CHD). A growing body of evidence suggests that neurologic dysfunction may be present in a significant proportion of this high-risk population in the early newborn period prior to surgi-cal interventions. We recently provided the first evidence that brain growth impairment in fetuses with complex CHD has its origins in utero. Here, we extend these observations by characterizing global and regional brain development in fetuses with hypoplastic left heart syndrome (HLHS), one of the most severe forms of CHD. Using advanced magnetic resonance imaging techniques, we com-pared in vivo brain growth in 18 fetuses with HLHS and 30 control fetuses from 25.4–37.0 weeks of gestation. Our findings demon-strate a progressive third trimester fall-off in cortical gray and white matter volumes (P< 0.001), and subcortical gray matter (P< 0.05) in fetuses with HLHS. Significant delays in cortical gyrifi