Prenatal influence of congenital heart defects on trajectories of cortical folding of the fetal brain using three‐dimensional ultrasound

Koning, Irene; Graafeiland, Anne W. van; Groenenberg, Irene A.L.; Husen, S.; Go, Attie T.J.I.; Dudink, Jeroen; Willemsen, Sten P.; Cornette, Jérôme; Steegers‐Theunissen, Régine P.M.

doi:10.1002/pd.5135

Cited by 7 publications

(28 citation statements)

References 46 publications

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“…Thus, the used methodology in this study is capable of determining the extent of the delay, which was demonstrated to be small (3 days). Moreover, we do not see a difference in the slopes of the development between CHD and control cases, indicating no further delay in the cortical growth trajectory in the third trimester, as described by other authors . A possible explanation for this absence of third trimester difference might be that the role of fetal brain oxygenation is being magnified in the literature due to case selection.…”

Section: Discussionsupporting

confidence: 72%

“…Cortical maturation by measuring fissure depth has been described before using both MRI and US in non‐CHD fetuses.Application of these techniques shows significant differences in the depth of the POF and calcarine fissure in CHD cases as compared with controls . These fissures were also reported to be shallower in CHD neonates than in controls with a comparable GA, which was explained as delayed maturation.…”

Section: Discussionmentioning

confidence: 92%

“…A common method of assessing fetal cortical development in the previously mentioned studies is a manual, sometimes unblinded, measurement of the depth of two to three fissures . The applied algorithm in our study automatically selects the most age‐discriminating regions of the entire fetal brain.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies suggest, however, that signs of abnormal neurological development may be present prior to surgery . Imaging studies in pregnancy using magnetic resonance imaging (MRI) and ultrasound, have shown signs of delayed fetal brain development. It has been suggested that it is these abnormal findings that result in the altered neurological outcome later in life .…”

Section: Introductionmentioning

confidence: 99%

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Cortical development in fetuses with congenital heart defects using an automated brain‐age prediction algorithm

Everwijn

Namburete

Geloven

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Congenital heart defects are associated with neurodevelopmental delay. It is hypothesized that fetuses affected by congenital heart defect have altered cerebral oxygen perfusion and are therefore prone to delay in cortical maturation. The aim of this study was to determine the difference in fetal brain age between consecutive congenital heart defect cases and controls in the second and third trimester using ultrasound. Material and methods Since 2014, we have included 90 isolated severe congenital heart defect cases in the Heart And Neurodevelopment (HAND)‐study. Every 4 weeks, detailed neurosonography was performed in these fetuses, including the recording of a 3D volume of the fetal brain, from 20 weeks onwards. In all, 75 healthy fetuses underwent the same protocol to serve as a control group. The volumes were analyzed by automated age prediction software which determines gestational age by the assessment of cortical maturation. Results In total, 477 volumes were analyzed using the age prediction software (199 volumes of 90 congenital heart defect cases; 278 volumes of 75 controls). Of these, 16 (3.2%) volume recordings were excluded because of imaging quality. The age distribution was 19‐33 weeks. Mixed model analysis showed that the age predicted by brain maturation was 3 days delayed compared with the control group (P = .002). Conclusions This study shows that fetuses with isolated cases of congenital heart defects show some delay in cortical maturation as compared with healthy control cases. The clinical relevance of this small difference is debatable. This finding was consistent throughout pregnancy and did not progress during the third trimester.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cortical development in fetuses with congenital heart defects using an automated brain‐age prediction algorithm

Everwijn

Namburete

Geloven

et al. 2019

Acta Obstet Gynecol Scand

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“…Finally, fetuses with CHD have higher serum s‐Flt and soluble Endoglin levels as well as increased s‐Flt in the frontal cortex and the basal ganglia of the brain . The combination of suboptimal perfusion with an anti‐angiogenic milieu results in alterations in structural brain development in utero, especially in the third trimester . The accumulation of data showing abnormal neurodevelopment in fetuses with hypoplastic left heart triggered the International Society for Ultrasound in Obstetrics and Gynecology to release a position statement in 2017 encouraging caregivers to discuss these prenatal findings with expecting couples and to warn them of the potential impact they may have on long‐term developmental outcomes …”

Section: Advances In Diagnosis and Treatment Of Fetal Cardiac Anomaliesmentioning

confidence: 99%

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2017

et al. 2018

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The association between flow and oxygenation and cortical development in fetuses with congenital heart defects using a brain‐age prediction algorithm

et al. 2020

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Objectives Presumably, changes in fetal circulation contribute to the delay in maturation of the cortex in fetuses with congenital heart defect (CHD). The aim of the current study is to analyze fetal brain development based on hemodynamic differences, using novel brain‐age prediction software. Methods We have performed detailed neurosonography, including acquiring 3D volumes, prospectively in cases with isolated CHD from 20 weeks onwards. An algorithm that assesses the degree of fetal brain‐age automatically was used to compare CHD cases to controls. We stratified CHD cases according to flow and oxygenation profiles by lesion physiology and performed subgroup analyses. Results A total of 616 ultrasound volumes of 162 CHD cases and 75 controls were analyzed. Significant differences in maturation of the cortex were observed in cases with normal blood flow toward the brain (−3.8 days, 95%CI [−5.5; −2.0], P = <.001) and low (−4.0 days, 95% CI [−6.7; −1.2] P = <.05; hypoplastic left heart syndrome[HLHS]) and mixed (−4.4 days, 95%CI [−6.4; −2.5] p = <.001) oxygen saturation in the ascending aorta (TGA) and in cardiac mixing (eg, Fallot) cases. Conclusion The current study shows significant delay in brain‐age in TGA and Fallot cases as compared to control cases. However, the small differences found in this study questions the clinical relevance.

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Prenatal influence of congenital heart defects on trajectories of cortical folding of the fetal brain using three‐dimensional ultrasound

Abstract: Fetal cortical folding can be evaluated reliably by measuring brain fissure depths. Trajectories of cortical folding between 22 and 32 weeks' GA seem to be influenced by CHD. © 2017 John Wiley & Sons, Ltd.

Cited by 7 publications

References 46 publications

Cortical development in fetuses with congenital heart defects using an automated brain‐age prediction algorithm

Cortical development in fetuses with congenital heart defects using an automated brain‐age prediction algorithm

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2017

The association between flow and oxygenation and cortical development in fetuses with congenital heart defects using a brain‐age prediction algorithm

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