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.