Differences in fetal brain development

With the advances in fetal surveillance, surgical techniques, and intensive care, congenital heart patients with single ventricle pathophysiology have seen longer life expectancies. Given this, discussion has shifted to fetal brain differences and long-term neurodevelopmental outcomes. Patients with congenital heart defects are at risk for neurologic differences as early as the fetal period due to the altered cardiac structure and its impact on systemic intrauterine nutrient and oxygen delivery in the setting of genetic and epigenetic factors. The genetic background of patients with congenital anomalies is an important consideration when discussing neurodevelopmental trajectories. However, fetal brain changes are recognized in the absence of identified genetic abnormalities, suggesting that other mechanisms contribute. This chapter highlights the typical trajectory of fetal brain development and describes distinct types of brain changes recognized in those with single ventricle pathophysiology.