Adverse neurological performance with critical congenital heart diseases mainly from prenatal injury not cardiac surgery: current evidence based on a meta-analysis of functional magnetic resonance imaging

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Ultrasound in Obstetrics and Gynecology. June 2014, 45(6).

  • Yifei Li,Senlin Yin4,†,
  • Jie Fang5,†,
  • Yimin Hua1,2,3,
  • Chuan Wang1,2,4,
  • Dezhi Mu1,2,3 and
  • Kaiyu Zhou1,2,3,*

No consensus has been reached regarding whether congenital heart disease (CHD) related brain injury is caused by cardiac surgery or prenatal injury of CHD. We performed this meta-analysis to identify the likely cause of adverse neurological performance in CHD patients.


Literature search was done in Dec, 2013 and records were retrieved from PubMed, Embase, the Cochrane Library and WHO trails center without language restriction. Studies applying functional magnetic resonance imaging (fMRI) evaluation of brain function before and after surgery were included. The preoperative and postoperative fMRI results were extracted, and meta-analysis was performed using Revman 5.1.1 and STATA 11.0, according to the guidelines from the Cochrane review group and the MOOSE guidance.


A total of 937 citations were yielded from electronic search. Full-texts were retrieved for 16 articles and the following studies were eligible for inclusion: 6 studies (n = 327 cases) with fMRI analysis before surgery and 3 studies (n = 36 cases) with completing perioperative fMRI analysis. The overall average diffusivity of CHD cases was significant higher with a summarized Std. Mean Difference of 1.39 (95% CI=0.70, 2.08), and the fractional anisotropy was lower in CHD cases with a summarized Std. Mean Difference of −1.34 (95% CI= − 1.64, −1.04). NAA/Cho and Lac/Cho were recorded in CHD cases with significant differences compared to healthy ones. In postoperative near term, significant change in NAA/Cr and NAA/Cho were found. However, the difference was not found in follow up.


The meta-analysis demonstrated the delay in neurological development in newborns with congenital heart disease, and cardiac surgery might lead to mild brain injuries postoperatively, but recovery of fMRI evaluation has been identified during the follow-up.

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