Neurodevelopment in tetralogy of fallot and its relationship with other congenital heart diseases: a narrative review
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Abstract
As the survival of patients with tetralogy of Fallot increases, profound changes in the neurodevelopment of these children and adolescents have been observed. This narrative review aims to provide a comprehensive overview of this topic, seeking to understand the intimate relationship between the brain and heart in patients with tetralogy of Fallot. Neurological dysfunctions frequently occur in this group of heart disease patients. Various dysfunctions are observed, such as alterations in executive function, speech and language processing, visuospatial processing, social and cognition, among others. Brain MRI findings have not been systematically correlated with these dysfunctions, but advanced MRI methods seem promising. Nevertheless, a better understanding of predictive factors for neurodevelopmental changes needs to be further explored. Regarding neuropsychiatric disorders, several studies have pointed to a higher occurrence of psychiatric alterations in general, with special attention to attention deficit hyperactivity disorder. Genetic factors have a significant influence on these alterations, although the multifactorial nature appears prominent. It is worth noting that findings suggestive of fetal brain development alterations reinforce the importance of genetic factors, but without limiting them. Hemodynamic changes that subject the brain to more significant intrauterine hypoxemia seem to play a relevant role in the observed alterations. Neurodevelopmental changes are, therefore, a challenging scenario for all those involved in the care of patients with tetralogy of Fallot. Understanding this complex relationship may bring future benefits in developing treatments aimed at achieving better long-term neuropsychiatric outcomes.
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