Atypical Cortical Asymmetries in Toddlers with Congenital Heart Disease Before Surgery.

BACKGROUND: Patients with congenital heart disease (CHD) may exhibit atypical structural asymmetry in the brain, while the altered structural lateralization and its relationship with cognitive function have not been fully revealed. METHODS: We performed a cross-sectional structural imaging study of 109 toddlers of CHD, including 80 with mild CHD, 29 with moderate-severe CHD in our hospital and 56 normal controls (NC). Surface-based image analysis was used to compute lateralization index (LI) for cortical surface area (CSA), cortical thickness (CT), and cortical volume (CV) in CHD groups and NC group across 34 bilateral regions. Group comparisons were conducted using generalized linear models, and partial correlation analyses were performed to examine associations between LIs, clinical variables, and developmental quotients (DQs) assessed by the Gesell Developmental Scale. RESULTS: Compared to the NC group, both the mild and moderate-severe CHD groups showed overlapping altered lateralization regions in the caudal anterior cingulate gyrus, pars opercularis, superior temporal gyrus, cuneus cortex, medial orbitofrontal gyrus, parahippocampal gyrus, and posterior cingulate cortex (p_FDR < 0.05). Moreover, the LI of CT in the pars opercularis was negatively associated with personal-social skills DQ in the CHD group (r = -0.327, p＜0.001 uncorrected; p_FDR = 0.021). CONCLUSIONS: Mild and moderate-severe CHD groups showed comparable alterations in cerebral asymmetries, predominantly involving perisylvian and default-mode network regions. Notably, the association between the LI of CT in the pars opercularis and personal-social skills DQ highlights a potential structural correlate of neurodevelopmental risk in CHD.