Introduction

Congenital Heart Disease (CHD) is the most prevalent congenital malformation, with implications extending into cognitive, language, and motor developmental delays during infancy and early childhood among affected patients. These developmental challenges often persist into school age and adolescence, impacting educational attainment and long-term outcomes in adulthood. Prior to surgical intervention, brain injuries such as White Matter Injury (WMI), hemorrhagic injury, and stroke are observed in approximately 39% of neonates with complex CHD, and this incidence may rise to 56% postoperatively, particularly in cases of univentricular CHD [1]. However, within the CHD population, existing research presents conflicting findings regarding the relationship between perioperative brain injuries and subsequent neurodevelopmental outcomes. Some studies indicate that neonatal brain injury correlates with neurologic abnormalities, reduced cognitive performance at one year of age, impaired cognitive and motor development at two years of age, and poorer cognition by six years of age. In contrast, a significant study reported no association between brain injury and outcomes at the two-year mark [2]. The inconsistent correlation between brain injury and developmental outcomes may stem from varied definitions of injury severity and differing prevalence rates across centers, influenced by methodological discrepancies in criteria for inclusion, surgical and perioperative procedures, and MRI protocols.

Neurodevelopmental outcomes

Our study aimed to explore the association between the overall burden of brain injury during the perioperative period and developmental outcomes in children with Congenital Heart Disease (CHD) who underwent cardiopulmonary bypass surgery within the first six weeks of life across three European centers [3]. We assessed brain injury using standardized preoperative and postoperative imaging criteria, as previously described, and calculated a comprehensive brain injury score based on the type and location of injuries. We hypothesized that a higher brain injury score would be linked to poorer neurodevelopmental outcomes during the first two years of life. Angiogenesis, the formation of new blood vessels from existing vasculature, is crucial for normal growth and development. Evidence indicates its role in embryonic development, and abnormalities in angiogenesis are associated with various developmental anomalies such as urogenital tract malformations, preeclampsia, and arteriovenous malformations. Recent studies have shown that environmental factors can disrupt angiogenesis in zebrafish embryos [4]. There are also reports suggesting correlations between certain environmental substances like DBP metabolites and angiogenesis biomarkers during pregnancy, although the specific mechanisms remain unclear.

Vascular development

The Androgen Receptor (AR) pathway significantly influences male-specific traits during various stages of development, including embryogenesis, spermatogenesis, sexual behavior, and fertility in adulthood. Studies have indicated that exposure to DBP can decrease AR expression, which plays a role in vascular development in specific cells of the genital tubercle. However, the precise molecular mechanisms by which DBP affects morphological and vascular development in neonatal hypospadias patients remain to be fully elucidated. Amid the COVID-19 pandemic, there have been widespread reports of decreased hospitalizations for Heart Failure (HF), along with emerging evidence suggesting poorer long-term outcomes for those who do require admission [5]. Furthermore, substantial strides have been made in comprehending the optimal management of patients with both HF and COVID-19 since the initial reports of COVID-19 cases in December 2019. However, as the transition of the COVID-19 pandemic toward an endemic phase unfolds slowly, coupled with varying global rates of vaccination, there is an urgent imperative to investigate and draw insights from how HF specialists have adapted HF care delivery in regions with distinct infection levels, vaccination rates, and healthcare infrastructures.

Reference

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