Cerebral blood flow autoregulation and congenital heart disease: possible causes of abnormal prenatal neurologic development

Arduini, M; Rosati, Paolo; Caforio, Leonardo; Guariglia, Lorenzo; Clerici, Graziano; Renzo, Gian Carlo Di; Scambia, Giovanni

doi:10.3109/14767058.2010.547961

Cited by 59 publications

(72 citation statements)

References 23 publications

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“…No other subtypes were associated with disproportionately smaller head circumference, as previously suggested in other studies of TOF, HLHS, or aortic arch hypoplasia. 13,15,20,[41][42][43] We found disproportionately larger head circumferences relative to birth weight in major VSDs and other less severe subtypes of CHD. No previous studies have reported such associations.…”

Section: Discussionmentioning

confidence: 84%

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Congenital Heart Defects and Indices of Fetal Cerebral Growth in a Nationwide Cohort of 924 422 Liveborn Infants

et al. 2016

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Background— Neurodevelopmental disorders are the most common and distressful comorbidities associated with congenital heart defects (CHD). Head circumference at birth (HC), a proxy for prenatal cerebral growth, is an established risk factor for neurodevelopmental disorders. Methods and Results— In a nationwide cohort, we included all 924 422 liveborn Danish singletons, 1997 to 2011. CHD was present in 5519. The association between CHD and growth indices was analyzed by multivariable linear regression, adjusted for potential confounders. We report mean differences in gestational age–specific z scores in comparison with the general population. CHD was associated with lower HC z scores, –0.10 (95% confidence interval [CI], –0.13 to –0.08). Several CHD subtypes were associated with smaller HC, eg, hypoplastic left heart syndrome, –0.39 (95% CI, –0.58 to –0.21); common arterial trunk, –0.41 (95% CI, –0.74 to –0.09); and major ventricular septal defects, –0.25 (95% CI, –0.35 to –0.15). Other single-ventricle defects, transposition of the great arteries, tetralogy of Fallot, and anomalous pulmonary venous return, were also associated with smaller HC. Transposition of the great arteries was associated with smaller HC relative to birth weight, –0.26 (95% CI, –0.39 to –0.13). Major ventricular septal defects were associated with larger HC relative to birth weight. The results were consistent under various conditions, eg, when siblings of infants with CHD (n=5311) or infants with other major malformations (n=24 974) were used as the reference. Conclusions— Several subtypes of CHD were associated with smaller HC. The associations with major ventricular septal defects, common arterial trunk, and anomalous pulmonary venous return have not previously been described. Only infants with transposition of the great arteries had smaller HC relative to birth weight.

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Section: Discussionmentioning

confidence: 84%

“…Ultrasound studies have demonstrated brain sparing in fetuses with CHD, 13,16,17,19,42,43 and MRI studies have demonstrated decreased fetal cerebral volume before birth. 7,14 Recently, measures of fetal cerebral oxygenation were directly linked to prenatal brain volume.…”

Section: Discussionmentioning

confidence: 99%

Congenital Heart Defects and Indices of Fetal Cerebral Growth in a Nationwide Cohort of 924 422 Liveborn Infants

et al. 2016

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“…Donofrio et al (20) were the first to report reduced head circumference (HC) measurements in fetuses with CHDs in the third trimester. Similarly, Arduini et al (21) found lower HC at 34 weeks' gestation. Masoller et al (22) documented, for the first time, that a remarkable fraction of fetuses with CHD already have biparietal diameter (BPD) and HC values below the 5th percentile (50% and 25%, respectively) for expected gestational age in the second trimester of pregnancy.…”

Section: Editorialmentioning

confidence: 97%

“…Ruiz et al (27) have found that fetuses with CHDs presented a small head at ultrasound diagnosis (BPD −1.32±0.99 Zs, HC −0.79±1.02 Zs), which remained small throughout gestation, a finding that was confirmed at birth (HC Zs −0.56±1. 21 CHDs presented an MCA and CPR below the 5th centile at the time of first examination. UtA and UA Doppler ultrasound parameters showed a significant increase towards the end of pregnancy, whereas no significant changes were observed for MCA or CPR with advancing gestational age.…”

Section: Editorialmentioning

confidence: 99%

Changes in biometry and cerebroplacental hemodynamics in fetuses with congenital heart diseases

Peixoto

Tonni²,

Júnior

2016

J. Thorac. Dis.

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“…Antenatally, normal distribution of oxygenated blood could be disturbed and vascular resistance may be altered in fetuses with CHD [3,6,7,8]. It has been reported that fetuses with left-sided obstructive lesions (LSOL) have lower pulsatility indices of the middle cerebral artery (MCA-PI) compared with fetuses without CHD [9].…”

Section: Introductionmentioning

confidence: 99%

Cerebral and Renal Oxygen Saturation Are Not Compromised in the Presence of Retrograde Blood Flow in either the Ascending or Descending Aorta in Term or Near-Term Infants with Left-Sided Obstructive Lesions

Laan

Mebius²,

Roofthooft³

et al. 2017

Neonatology

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Background: In infants with left-sided obstructive lesions (LSOL), the presence of retrograde blood flow in either the ascending or descending aorta may lead to diminished cerebral and renal blood flow, respectively. Objectives: Our aim was to compare cerebral and renal tissue oxygen saturation (rSO₂) between infants with LSOL with antegrade and retrograde blood flow in the ascending aorta and with and without diastolic backflow in the descending aorta. Methods: Based on 2 echocardiograms, the study group was categorized according to the direction of blood flow in the ascending and descending aorta. We measured cerebral and renal rSO₂ using near-infrared spectroscopy and calculated fractional tissue oxygen extraction (FTOE). Results: Nineteen infants with LSOL, admitted to the NICU between 0 and 28 days after birth, were included. Infants with antegrade blood flow (n = 12) and infants with retrograde blood flow in the ascending aorta (n = 7) had similar cerebral rSO₂ and FTOE during both echocardiograms. Only during the first echocardiogram, infants with retrograde blood flow in the ascending aorta had lower renal FTOE (0.14 vs. 0.32, p = 0.04) and tended to have higher renal rSO₂ (80 vs. 65%, p = 0.09). The presence of diastolic backflow in the descending aorta was not associated with cerebral or renal rSO₂ and FTOE during the first (n = 8) as well as the second echocardiogram (n = 10). Conclusions: Retrograde blood flow in the ascending aorta was not associated with cerebral oxygenation, while diastolic backflow in the descending aorta was not associated with renal oxygenation in infants with LSOL.

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Cerebral blood flow autoregulation and congenital heart disease: possible causes of abnormal prenatal neurologic development

Abstract: Cerebrovascular resistance is significantly lower in fetuses with CHD, especially in cases of left side obstruction. The cerebro/placental hemodynamic changes are similar to that described in fetuses with placental insufficiency and may contribute to their abnormal neurologic development.

Cited by 59 publications

References 23 publications

Congenital Heart Defects and Indices of Fetal Cerebral Growth in a Nationwide Cohort of 924 422 Liveborn Infants

Congenital Heart Defects and Indices of Fetal Cerebral Growth in a Nationwide Cohort of 924 422 Liveborn Infants

Changes in biometry and cerebroplacental hemodynamics in fetuses with congenital heart diseases

Cerebral and Renal Oxygen Saturation Are Not Compromised in the Presence of Retrograde Blood Flow in either the Ascending or Descending Aorta in Term or Near-Term Infants with Left-Sided Obstructive Lesions

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