Purpose or Case Report: The placenta-heart-brain axis plays a central role in fetal growth and neurodevelopment and is increasingly recognized as critical in the congenital heart disease (CHD). Increasing evidence suggests that placental maldevelopment and fetoplacental circulatory abnormalities are associated with impaired cardiac morphogenesis and cerebral injury, which may contribute to neurodevelopmental deficits observed in CHD.
Prenatal magnetic resonance imaging (MRI) provides a comprehensive, noninvasive means to evaluate this axis in vivo. Quantitative placental MRI techniques, including T2* mapping, arterial spin labeling, and diffusion imaging, reveal altered oxygenation, perfusion, and microstructure in CHD pregnancies. Fetal cardiac MRI enables high-resolution assessment of complex cardiac anatomy, ventricular function, and blood flow using motion-robust acquisitions and innovative gating methods. Cerebral MRI further demonstrates structural, metabolic, and connectivity alterations consistent with impaired substrate and oxygen delivery.
Together, these findings highlight prenatal MRI as a powerful tool for understanding how placental and cardiovascular physiology influence brain development in CHD. Integrating placental, cardiac, and cerebral imaging biomarkers could enhance prenatal risk stratification, guide perinatal management, and inform early neuroprotective strategies. Continued technical refinement and longitudinal validation will be essential to achieve clinical translation and improve long-term outcomes.
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