Neurodesenvolvimento na tetralogia de fallot e sua relação com outras cardiopatias congênitas: uma revisão narrativa
Contenido principal del artículo
Resumen
Conforme aumenta a sobrevida de pacientes com tetralogia de Fallot, observam-se alterações profundas no neurodesenvolvimento dessas crianças e adolescentes. O objetivo desta revisão narrativa é lançar um olhar abrangente sobre este tema, buscando compreender a relação íntima entre cérebro e coração nos pacientes com tetralogia de Fallot. Alterações do funcionamento neurológico ocorrem de forma frequente neste grupo de cardiopatia. Observam-se diversas disfunções, como alterações da função executiva, processamento de fala e linguagem, processamento visuoespacial, cognição social, entre outras. Achados de ressonância magnética cerebral não foram sistematicamente correlacionados com essas disfunções, mas métodos avançados de ressonância parecem ser promissores. Ainda assim, é necessário compreender melhor os fatores preditivos das alterações do neurodesenvolvimento. No que tange aos transtornos neuropsiquiátricos, diversos estudos apontaram maior ocorrência de alterações psiquiátricas de uma maneira geral, com especial atenção para o transtorno de déficit de atenção e hiperatividade. Fatores genéticos parecem ter influência significativa nessas alterações, embora a natureza multifatorial seja marcante. Vale ressaltar que achados sugestivos de alterações do desenvolvimento cerebral do feto vêm reforçando a importância de fatores genéticos, mas sem limitar a eles. Alterações hemodinâmicas que submetem o cérebro à maior hipoxemia intraútero parecem ter papel relevante nas alterações encontradas. Alterações do neurodesenvolvimento são, portanto, um cenário desafiador para todos os envolvidos com os cuidados de pacientes com tetralogia de Fallot. Compreender essa complexa relação pode trazer benefícios futuros no desenvolvimento de tratamentos que busquem melhor resultado neuropsiquiátrico no longo prazo.
Descargas
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Citas
1. Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health. 2020;4(3):185-200.
2. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982-3021.
3. Su Z, Zou Z, Hay SI, Liu Y, Li S, Chen H, et al. Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study. eClinicalMedicine. 2022;43:101249.
4. Kordopati-Zilou K, Sergentanis T, Pervanidou P, Sofianou-Petraki D, Panoulis K, Vlahos N, et al. Neurodevelopmental Outcomes in Tetralogy of Fallot: A Systematic Review. Children (Basel). 2022;9(2).
5. Mercer-Rosa L, Favilla E. Neurodevelopment in patients with repaired tetralogy of Fallot. Front Pediatr. 2024;12:1137131.
6. Miatton M, De Wolf D, François K, Thiery E, Vingerhoets G. Intellectual, neuropsychological, and behavioral functioning in children with tetralogy of Fallot. J Thorac Cardiovasc Surg. 2007;133(2):449-55.
7. Hövels-Gürich HH, Konrad K, Skorzenski D, Nacken C, Minkenberg R, Messmer BJ, et al. Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy. Ann Thorac Surg. 2006;81(3):958-66.
8. Hövels-Gürich HH, Bauer SB, Schnitker R, Willmes-von Hinckeldey K, Messmer BJ, Seghaye MC, et al. Long-term outcome of speech and language in children after corrective surgery for cyanotic or acyanotic cardiac defects in infancy. Eur J Paediatr Neurol. 2008;12(5):378-86.
9. Hövels-Gürich HH, Konrad K, Skorzenski D, Minkenberg R, Herpertz-Dahlmann B, Messmer BJ, et al. Long-term behavior and quality of life after corrective cardiac surgery in infancy for tetralogy of Fallot or ventricular septal defect. Pediatr Cardiol. 2007;28(5):346-54.
10. Bellinger DC, Rivkin MJ, DeMaso D, Robertson RL, Stopp C, Dunbar-Masterson C, et al. Adolescents with tetralogy of Fallot: neuropsychological assessment and structural brain imaging. Cardiol Young. 2015;25(2):338-47.
11. Morton SU, Maleyeff L, Wypij D, Yun HJ, Rollins CK, Watson CG, et al. Abnormal Right-Hemispheric Sulcal Patterns Correlate with Executive Function in Adolescents with Tetralogy of Fallot. Cereb Cortex. 2021;31(10):4670-80.
12. Morton SU, Maleyeff L, Wypij D, Yun HJ, Newburger JW, Bellinger DC, et al. Abnormal Left-Hemispheric Sulcal Patterns Correlate with Neurodevelopmental Outcomes in Subjects with Single Ventricular Congenital Heart Disease. Cereb Cortex. 2020;30(2):476-87.
13. Im K, Grant PE. Sulcal pits and patterns in developing human brains. Neuroimage. 2019;185:881-90.
14. Favilla E, Faerber JA, Hampton LE, Tam V, DeCost G, Ravishankar C, et al. Early Evaluation and the Effect of Socioeconomic Factors on Neurodevelopment in Infants with Tetralogy of Fallot. Pediatr Cardiol. 2021;42(3):643-53.
15. Murphy LK, Compas BE, Reeslund KL, Gindville MC, Mah ML, Markham LW, et al. Cognitive and attentional functioning in adolescents and young adults with Tetralogy of Fallot and d-transposition of the great arteries. Child Neuropsychol. 2017;23(1):99-110.
16. Czobor NR, Ocsovszky Z, Roth G, Takács S, Csabai M, Székely E, et al. ADHD symptomatology of children with congenital heart disease 10 years after cardiac surgery: the role of age at operation. BMC Psychiatry. 2021;21(1):316.
17. Holst LM, Kronborg JB, Jepsen JRM, Christensen J, Vejlstrup NG, Juul K, et al. Attention-deficit/hyperactivity disorder symptoms in children with surgically corrected Ventricular Septal Defect, Transposition of the Great Arteries, and Tetralogy of Fallot. Cardiol Young. 2020;30(2):180-7.
18. Holland JE, Cassidy AR, Stopp C, White MT, Bellinger DC, Rivkin MJ, et al. Psychiatric Disorders and Function in Adolescents with Tetralogy of Fallot. J Pediatr. 2017;187:165-73.
19. Hsu WF, Chien WC, Chung CH, Lee PC, Wang DS, Huang SW, et al. Association Between Tetralogy of Fallot and Psychiatric Disorders: A Nationwide Cohort Study. J Clin Psychiatry. 2021;82(2).
20. Gaynor JW, Gerdes M, Nord AS, Bernbaum J, Zackai E, Wernovsky G, et al. Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy? J Thorac Cardiovasc Surg. 2010;140(6):1230-7.
21. Ma SY, Liu YT, Cun YS, Wang Q, Fu MC, Wu KD, et al. Preoperative serum cortisone levels are associated with cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: new evidence from human populations and mice. World J Pediatr. 2024;20(2):173-84.
22. De Asis-Cruz J, Donofrio MT, Vezina G, Limperopoulos C. Aberrant brain functional connectivity in newborns with congenital heart disease before cardiac surgery. Neuroimage Clin. 2018;17:31-42.
23. McQuillen PS, Barkovich AJ, Hamrick SE, Perez M, Ward P, Glidden DV, et al. Temporal and anatomic risk profile of brain injury with neonatal repair of congenital heart defects. Stroke. 2007;38(2 Suppl):736-41.
24. Limperopoulos C, Tworetzky W, McElhinney DB, Newburger JW, Brown DW, Robertson RL, Jr., et al. Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation. 2010;121(1):26-33.
25. Schellen C, Ernst S, Gruber GM, Mlczoch E, Weber M, Brugger PC, et al. Fetal MRI detects early alterations of brain development in Tetralogy of Fallot. Am J Obstet Gynecol. 2015;213(3):392.e1-7.
26. Licht DJ, Shera DM, Clancy RR, Wernovsky G, Montenegro LM, Nicolson SC, et al. Brain maturation is delayed in infants with complex congenital heart defects. J Thorac Cardiovasc Surg. 2009;137(3):529-36; discussion 36-7.
27. Miller SP, McQuillen PS, Hamrick S, Xu D, Glidden DV, Charlton N, et al. Abnormal brain development in newborns with congenital heart disease. N Engl J Med. 2007;357(19):1928-38.
28. Benítez-Marín MJ, Marín-Clavijo J, Blanco-Elena JA, Jiménez-López J, González-Mesa E. Brain Sparing Effect on Neurodevelopment in Children with Intrauterine Growth Restriction: A Systematic Review. Children (Basel). 2021;8(9).
29. Mahle WT, Tavani F, Zimmerman RA, Nicolson SC, Galli KK, Gaynor JW, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation. 2002;106(12 Suppl 1):I109-14.
30. Yang M, Liu Y, Ma S, Wang S, Fu M, Zhu M, et al. Altered brain structure in preschool-aged children with tetralogy of Fallot. Pediatr Res. 2023;93(5):1321-7.