Fetuses with congenital heart disease demonstrate signs of decreased cerebral impedance

Modena, Alisa; Horan, Colleen; Visintine, John; Chanthasenanont, Athita; Wood, Dennis; Weiner, Stuart

doi:10.1016/j.ajog.2006.05.045

Cited by 44 publications

(48 citation statements)

References 17 publications

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“…The results also confirm previous data suggesting impaired neurodevelopment in fetuses with CHD, including a significantly smaller head biometry at diagnosis [34] or in the third trimester [35,36], brain redistribution [16,17,34,35,37,38], smaller MRI TBrV and TICV [11,12] and a delay in cortical gyrification [12,13]. Finally, we found similar MRI spectroscopic results to those previously reported for neonates [10] and third-trimester fetuses [11] with CHD, showing decreased mean NAA/Cho ratios in several brain areas.…”

Section: Discussionsupporting

confidence: 81%

“…This notion is supported by recent evidence that CHD fetuses have significant reductions in O 2 content in the ascending aorta and in brain oxygen consumption [15]. From a clinical perspective, if reduced placental blood supply is involved in brain injury in CHD, those cardiac defects causing the most severe reductions in the mix of oxygenated blood to the brain should be associated with a higher risk of neurological injury [16]. Thus, several studies have reported more pronounced changes in head biometry and brain Doppler parameters in cases with hypoplastic left heart syndrome (HLHS) or transposition of the great arteries (TGA) in comparison with right heart defects [17,18,19].…”

Section: Introductionsupporting

confidence: 60%

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Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

et al. 2015

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Objectives: We evaluated the hypothesis that in fetuses with congenital heart disease (CHD) there is a correlation between the expected pattern of in utero brain blood supply and the severity of neurodevelopmental impairment. Methods: A total of 58 fetuses with CHD and 58 controls underwent a Doppler ultrasound and fetal MRI at 36-38 weeks. Fetuses with CHD were divided into two functional classes: class A with an expected severe reduction in oxygenated brain blood supply (left outflow tract obstruction and transposition of great vessels) and class B with theoretically near-normal or mildly impaired oxygenated brain blood supply (other CHD). Head biometry and cerebroplacental Doppler were assessed by ultrasound, and brain volumetry, cortical development and metabolism by MRI. Results: Both class A and B CHD fetuses had significant differences in head biometry, brain perfusion, cortical development and brain metabolism compared with controls. However, there was a significant linear tendency for head biometry, cerebral Doppler, volumes, cortical sulcation and metabolic ratios across the three clinical groups, with signs of more severe brain alterations in type A CHD fetuses. Conclusions: All fetuses with CHD showed significant brain developmental changes, but differences were more pronounced in CHD associated with an expected severe reduction in oxygenated blood supply to the brain.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionsupporting

confidence: 60%

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

et al. 2015

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“…As a result, the oxygen content of blood delivered to the brain is low and the cerebral vasodilation that occurs in the fetus with CHD is an attempt to compensate for cerebral hypoxemia. Modena et al [12] reported that fetuses with congenital heart defects are significantly more likely to have decreased cerebrovascular impedance due to intracardiac mixing of oxygenated and deoxygenated blood (p = 0.023). The relatively small number of patients in the non-mixing group prevented demonstrating statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…To compare Doppler results independent of gestational age, Z-score conversions were done [11,12,15] and individual PI measurements were converted into Z-scores based on published, normative data from a large Chinese population of healthy fetuses [16] . Because the data were not normally distributed, we used nonparametric measures of distribution (median and interquartile ranges) and Kruskal-Wallis with post-hoc Mann-Whitney U testing to determine differences between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Shaohui

Peng

et al. 2009

Fetal Diagn Ther

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Objective: The aim of this study was to determine whether the type of congenital heart disease (CHD) or heart function influence fetal cerebrovascular blood flow dynamics. Methods: Doppler flow velocimetry was performed in the umbilical artery (UA) and middle cerebral artery (MCA), and the ratio of the UA pulsatility index (PI) to the MCA PI (U/C PI) was determined in 45 fetuses with CHD at 20–40 weeks’ gestational age. The control group consisted of 275 healthy fetuses matched for gestational age. Individual PI measurements were converted into Z-scores for statistical analysis. Results: Fetuses with CHD (n = 45) had an increased UA PI (p = 0.001) and U/C PI (p < 0.001) when compared to controls. There was no significant difference in the MCA PI between fetuses with CHD (n = 45) and controls (n = 275), while fetuses with CHD complicated by congestive heart failure (CHF) (n = 10) had a decreased MCA PI (p < 0.001) compared to controls. Conclusions: The lower PIs observed in the MCA of fetuses with CHD complicated by CHF represents a marker of cerebral vasodilation that is due to cerebral hypoxemia and limiting perfusion. The heart function and type of CHD have an impact on fetal cerebrovascular blood flow distribution and this may contribute to the cause of abnormal neurologic development in these fetuses.

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“…Exclusion criteria were as follows: (1) identifiable extracardiac malformation; (2) identifiable chromosomal abnormality; (3) persistent non-sinus rhythm; (4) maternal conditions that might affect fetal hemodynamics, such as gestational diabetes, thyroid disease, or pregnancy induced hypertension, and (5) multiple pregnancy. On the basis of anatomic structures of cardiac defects, we divided the fetuses with CHD into 3 groups: (1) leftsided obstructive lesions (n = 4); (2) right-sided obstructive lesions (n = 15), and (3) mixed type of CHD (n = 25) [9] . The gestational ages were determined by the last menstrual period and ascertained by a crown-rump length during the first trimester.…”

Section: Study Populationmentioning

confidence: 99%

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

Itsukaichi

Kikuchi²,

Yoshihara³

et al. 2011

Fetal Diagn Ther

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Objective: Our aim was to investigate the association between fetal growth and cerebrovascular resistance in fetuses with congenital heart disease (CHD). Methods: Fetal echocardiography was performed to measure the biparietal diameter, abdominal circumference, femur length, estimated fetal body weight, middle cerebral artery (MCA) resistance index (RI) and umbilical artery (UA) RI in 44 fetuses with CHD and 140 normal fetuses at a gestational age of 28–34 weeks. Results: Fetuses with CHD exhibited significantly lower values for femur length, estimated fetal body weight at the third trimester, body weight, length, and chest circumference at birth than normal controls. The percentages of fetuses showing MCA RI values <10th percentile and UA RI values >90th percentile were significantly higher in the CHD group than in the control group. However, there were no significant differences in any biometric parameters measured between cases with MCA RI values ≧10th percentile and values <10th percentile. Conclusions: Growth restriction and blood flow changes were observed significantly more frequently in fetuses with CHD than in those without CHD. Further studies are necessary to clarify the association between fetal growth and dynamic changes in fetal circulation.

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Fetuses with congenital heart disease demonstrate signs of decreased cerebral impedance

Cited by 44 publications

References 17 publications

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

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

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