Response to “Doppler evaluation of the posterior cerebral artery in normally grown and growth restricted fetuses”

Abstract

Response to "Doppler evaluation of the posterior cerebral artery in normally grown and growth restricted fetuses"We appreciate the constructive comments of Dr Morales Rosello et al. to our paper 'Doppler evaluation of the posterior cerebral artery in normally grown and growth restricted fetuses'. We are also very grateful for the phylogenetic explanation on the development of the vascular segments of the cranial arteries. We would like to clarify some points and make some additional comments. We have been evaluating the major cerebral arteries in intrauterine growth restricted fetuses using not only spectral Doppler, but also power Doppler for evaluation of blood perfusion using a technique named Fractional Moving Blood Volume. 1-3 Our results consistently show that the frontal lobe and anterior cerebral artery are affected before the middle cerebral artery. 1,2 We were able to document earlier changes in the posterior cerebral artery than in the middle cerebral artery, 1 data that were confirmed in the present study. 4 However, we still cannot conclude that the hierarchical deterioration always starts in the anterior cerebral artery, it might be possible that the posterior cerebral artery and, most important, the vertebral arteries might be affected first. The contribution of the vertebral system to the process of brain blood flow redistribution has been systematically forgotten, only few papers are available on changes in the vertebral arteries in intrauterine growth restricted fetuses. [5][6][7] Our opinion is that the vertebral artery should be included in the complete hemodynamic evaluation of the fetal cranial circulation.