TY - CHAP M1 - Book, Section TI - Neurology of Congenital Cardiovascular Disease: Brain Development, Acquired Injury, and Neurodevelopmental Outcome A1 - Artman, Michael A1 - Mahony, Lynn A1 - Teitel, David F. PY - 2017 T2 - Neonatal Cardiology, 3e AB - Dramatic advances in noninvasive imaging, cardiopulmonary bypass, surgical technique, and intensive care now allow most patients with congenital cardiovascular defects to undergo surgery during the neonatal period or in later infancy. With these advances, mortality has declined, but many patients are at risk for neurodevelopmental impairment. A natural assumption was that adverse neurologic outcome was directly related to brain injury sustained during neonatal surgical intervention, leading to a seminal study in the late 1980s. The Boston Circulatory Arrest Trial compared two methods of vital organ support in infants undergoing open-heart surgery to repair d-transposition of the great arteries. Much of what is known about the relationship between early intervention for complex cardiovascular disease and neurodevelopmental outcome has been gleaned from this study. However, it is now apparent that injury to the brain may occur during fetal life, at birth, preoperatively, intraoperatively, and postoperatively. The interplay between brain development and the circulation is complex and occurs at many levels. This chapter reviews mechanisms influencing neurologic outcome, including (1) shared genetic and developmental pathways, (2) physiologic effects of congenital cardiovascular lesions on brain blood flow, and (3) the timing, appearance, and mechanism of acquired brain injuries. We summarize how these pathogenic mechanisms result in a neurodevelopmental “signature” of congenital cardiovascular disease. Finally, we will speculate on how these mechanisms suggest strategies of neuroprotection, repair, and recovery that may improve outcome. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/11/13 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1140364322 ER -