Changes in Fetal Circulation Associated with Congenital Heart Disease and Their Effects on Fetal Growth

Itsukaichi, Mina; Kikuchi, Akira; Yoshihara, Kosuke; Serikawa, Takehiro; Takakuwa, Koichi; Tanaka, Kenichi

doi:10.1159/000330202

Cited by 30 publications

(49 citation statements)

References 25 publications

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“…226,245,246 The CVP score may be useful in the baseline and serial evaluations for fetuses at risk for or with myocardial dysfunction. Finally, abnormalities of myocardial structure and function may affect the fetal circulation, including placental blood flow and fetal growth, 247 and conversely, placental pathology may contribute to fetal hemodynamic compromise through fetal hypoxia. 226,227 The assessment of umbilical artery pulsatility may be useful in these conditions.…”

Section: Cardiac Function Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Cardiac Function Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

View full text Add to dashboard Cite

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“…Eight studies included larger groups of mixed CHD, and five only included HLHS . Eight studies calculated z ‐scores or percentiles to correct for the effect of gestational age, using various normal reference populations (Table b) . One study reported absolute values at 34 weeks of gestation .…”

Section: Resultsmentioning

confidence: 99%

“…Most studies ( n = 14) calculated z ‐scores or percentiles to correct for the effect of the gestational age, using various normal reference populations (Table b) . Seven studies reported absolute values at a specific gestational age . Three articles were excluded from the meta‐analysis because the pulsatility indices were not available .…”

Section: Resultsmentioning

confidence: 99%

Fetal brain imaging in isolated congenital heart defects – a systematic review and meta‐analysis

et al. 2016

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Congenital heart defects (CHDs) are associated with neurodevelopmental (ND) delay. This study aims to assess evidence for impaired prenatal brain development, in fetuses with CHD. A systematical search was performed, and 34 studies evaluating the fetal brain [magnetic resonance imaging (MRI) or ultrasound] in isolated CHD were included . Data regarding cerebral abnormalities, head circumference growth and middle cerebral artery flow were extracted. Prenatal MRI was studied in ten articles (445 fetuses), resulting in a pooled prevalence of 18% (95%CI À6%; 42%) for combined structural and acquired cerebral abnormalities. Prenatal head circumference was studied in 13 articles (753 fetuses), resulting in a pooled z-score of À0.51 (95%CI À0.84; À0.18). Doppler was studied in 21 articles (1412 fetuses), resulting in a lower middle cerebral artery pulsatility index (z-score À0.70 95%CI À0.99; À0.41) in left-sided CHD only. We conclude that prenatal MRI and ultrasound demonstrate brain abnormalities, delay in head growth and brainsparing in subgroups of CHD. However, large MRI studies are scarce, and ultrasound data are biased towards severe and left-sided CHD. Long-term follow-up studies correlating prenatal findings with postnatal ND outcome are limited, and data are lacking to support counseling families regarding ND outcome based on prenatal findings suggestive of altered brain development.

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“…In adults, elevated MCA PSV has been reported in association with subarachnoid hemorrhage, cerebral edema leading to extravascular compression and vasospasm . Otherwise, it can be speculated that changes in MCA could be related with changes in cardiac function, as demonstrated in fetuses with congenital heart defects . All these alternative explanations require further consideration.…”

Section: Discussionmentioning

confidence: 97%

Preoperative prediction of the individualized risk of early fetal death after laser therapy in twin‐to‐twin transfusion syndrome

et al. 2013

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Objective The aim of this study is to evaluate the independent and combined value of gestational age, fetal weight, fetoplacental Doppler, and myocardial performance index for the prediction of individual risk of early (≤7 days) intrauterine fetal death (IUFD) after laser therapy in twin-to-twin transfusion syndrome (TTTS).Material and Methods A consecutive series of 215 cases of TTTS treated with laser therapy in three centers was prospectively studied. Ultrasound evaluation within 24 h of surgery included estimated fetal weight discordance, umbilical artery, pulsatility index (PI) and diastolic flow evaluation, middle cerebral artery PI and middle cerebral artery peak systolic velocity, ductus venosus PI and atrial flow assessment, and modified myocardial performance index. Logistic regression analysis was used to explore the association of preoperative parameters with IUFD.Results Intrauterine fetal death occurred in 17 (7.9%) of the recipients and 33 (15.3%) donors (p = 0.016). The only independent predictors of IUFD in recipients was the middle cerebral artery peak systolic velocity >1.5 MoM (OR = 22, p = 0.015), but this event was present in only 3% of recipients. In donors, reverse end diastolic flow in the umbilical artery (OR = 14.748, p = 0.033), estimated fetal weight discordance (OR = 1.054, p = 0.036), and gestational age (OR = 0.757, p = 0.046) were independent predictors. ConclusionIn TTTS, preoperative fetal assessment can identify independent risk factors for early post-operative IUFD, particularly in donors.

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Changes in Fetal Circulation Associated with Congenital Heart Disease and Their Effects on Fetal Growth

Cited by 30 publications

References 25 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Fetal brain imaging in isolated congenital heart defects – a systematic review and meta‐analysis

Preoperative prediction of the individualized risk of early fetal death after laser therapy in twin‐to‐twin transfusion syndrome

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