# Neurosonographic Evaluation of Cerebral Cortical Development in Fetuses With Congenital Heart Disease: A Systematic Review of the Literature

## TL;DR

This review finds that fetuses with heart defects show delayed brain development, detectable via ultrasound.

## Contribution

Ultrasound can detect cortical development delays in fetuses with congenital heart disease.

## Key findings

- Five studies showed delayed brain sulci and gyri development in CHD fetuses.
- Ultrasound is a useful tool for evaluating fetal cortical development.
- Postnatal studies are needed to assess long-term neurodevelopmental outcomes.

## Abstract

This systematic review collated data from neurosonography and ultrasound evaluations to assess changes in the cortical development of fetuses with congenital heart disease (CHD). Of the 135 articles identified by two independent reviewers, five that satisfied our inclusion criteria were selected. Cortical evaluation was performed by 2D and/or 3D ultrasound via either a transabdominal or transabdominal plus transvaginal approach. One study used a brain‐age evaluation algorithm, while the other four measured the depths of brain fissures. Gestational age at the time of fetal evaluation was very heterogeneous, from 20 to 37 weeks. Four of the studies included several types of CHD but one included only fetuses with tetralogy of Fallot. All five studies detected significant delays in the development of brain sulci and gyri in CHD fetuses compared to controls. In general, the studies were of good methodological quality, but all showed some risk of bias. The main methodological issue was the lack of comparison of ultrasound findings with magnetic resonance imaging data. To conclude, ultrasound was found useful in the evaluation of fetal cortical development, showing that fetuses with CHD present some degree of delayed cortical development, but postnatal studies are needed to understand if it correlates with impaired neurodevelopment.

What is already known about this topic?◦Congenital heart diseases are associated with impaired neurodevelopment in children and adolescents. Studies suggest that signs of abnormal neurological development appear prior to cardiac surgery. Research using magnetic resonance imaging has shown signs of delayed brain development in fetuses with congenital heart defects.What does this review add?◦The evidence provided by this comprehensive review suggests that cortical development delays in fetuses with isolated cardiac abnormalities exist and that ultrasound can detect such delays.

What is already known about this topic?

Congenital heart diseases are associated with impaired neurodevelopment in children and adolescents. Studies suggest that signs of abnormal neurological development appear prior to cardiac surgery. Research using magnetic resonance imaging has shown signs of delayed brain development in fetuses with congenital heart defects.

What does this review add?

The evidence provided by this comprehensive review suggests that cortical development delays in fetuses with isolated cardiac abnormalities exist and that ultrasound can detect such delays.