Longitudinal changes in fetal biometry and cerebroplacental hemodynamics in fetuses with congenital heart disease

Abstract

CHD fetuses have a relatively small head from the second trimester of pregnancy, regardless of the type of CHD anomaly, and increasing resistance in the UtA and UA as pregnancy progresses, suggestive of increasing degree of placental impairment. Our findings indicate the early onset of mechanisms that could lead to poorer neurodevelopment later in life. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Growth patterns in fetuses with isolated cardiac defects

“…A reduction in fetal brain volume has been reported in infants with different types of CHD . This is also reflected by smaller fetal and neonatal head circumferences (HCs) …”

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

“…(III) Group 3: expected high placental blood content, in which there was brain perfusion originated from the left ventricle via a correctly formed aorta (right CHD), including pulmonary stenosis, tricuspid atresia, Ebstein's anomaly and pulmonary atresia. 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.…”

“…Both MCA and CPR presented significant differences in longitudinal behavior between CHD groups. The main observations of the study by Ruiz et al (27) were that head biometry measurements remained smaller than normal throughout gestation and that placental hemodynamics showed impairment towards the end of pregnancy, regardless of the type of CHD anomaly. These findings might suggest that the cause of abnormal brain development could be already present from the beginning of pregnancy.…”

“…The study by Ruiz et al (27), although a retrospective analysis with small samples of fetuses with different CHD, may contribute to increase our knowledge on the potential growth of fetuses with CDH. In a previous study by the same authors (23), a linear correlation between neurodevelopment delay and clinical variables such as fetal brain volume, brain fissure depth and metabolic rations on MRI evaluation were demonstrated.…”

“…Ruiz et al (27) conducted an interesting retrospective study in two tertiary care centers in Spain, where 444 ultrasound examinations were performed between 20-24 weeks' gestation and 119 fetuses were detected with CHD. The primary aim of this study was to ascertain whether impairment in fetal head and body growth develops throughout gestation whereas the secondary aims were to establish if changes occurring could be related to the particular type of oxygen delivery to fetal brain and whether placental perfusion could be related to changes in head and body size in fetuses with CHD.…”