Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow

Yamamoto, Yuka; Khoo, Nee Scze; Brooks, Paul; Savard, Winnie; Hirose, Akiko; Hornberger, Lisa K.

doi:10.1002/uog.12448

Cited by 58 publications

(79 citation statements)

References 20 publications

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“…We also noticed that reducing the amount of outflow of the left ventricle, normalized the LV pressures and led to retrograde flow in the AoI, as supported by previous studies [12]. Nevertheless, when the whole aortic arch is hypoplastic (Scenario 4), less AoI retrograde flow is observed when increasing stenosis.…”

Section: Discussionsupporting

confidence: 87%

Assessment of Haemodynamic Remodeling in Fetal Aortic Coarctation Using a Lumped Model of the Circulation

Mínguez

Bijnens

Bernardino

et al. 2017

Functional Imaging and Modelling of the Heart

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Abstract. Introduction: Aortic coarctation is one of the most difficult cardiac defects to diagnose before birth, and it accounts for 8% of congenital heart diseases. Antenatal diagnosis is crucial for early treatment of the neonate and to decrease the risk of morbidity and mortality; however the fetal hemodynamic changes are not fully understood and current imaging methods are limited to accurately diagnosis this congenital defect. Objective: We propose to use a lumped model of the fetal circulation to provide insights into the hemodynamic changes in fetuses with aortic coarctation, and thus helping to improve its diagnosis. Methods: To achieve this goal a patient-specific lumped model of the fetal circulation was implemented in OpenCOR, including the modeling of different types and degrees of aortic coarctation. A parametric study of degree and type of coarctation was performed, where blood flow distribution, cerebroplacental ratio, pressure drop over the coarctation and left ventricular pressure were quantified. Results: Obvious changes in the fetal hemodynamics were observed only from 80% of coarctation, corresponding to the clinically used cutoff for pressure drop of 20 mmHg. Furthermore, the observed hemodynamic changes were different depending on the location and degree of the coarctation.

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Section: Discussionsupporting

confidence: 87%

Assessment of Haemodynamic Remodeling in Fetal Aortic Coarctation Using a Lumped Model of the Circulation

Mínguez

Bijnens

Bernardino

et al. 2017

Functional Imaging and Modelling of the Heart

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“…25 Aortic arch obstruction is associated with altered fetal cerebral blood flow and may therefore have an impact on neurodevelopmental outcomes. 26 Thirty-eight percent of the subjects had anatomy that required surgical palliation resulting in a single functional ventricle. Of these, 2 subjects with hypoplastic left heart syndrome underwent orthotopic heart transplantation during the study period.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Abnormal Developmental Trajectories in Young Children With Congenital Heart Disease

et al. 2015

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Background Children with congenital heart disease (CHD) are at risk for developmental delay (DD). This study sought to identify early risk factors for abnormal developmental trajectories in children with CHD. Methods and Results Children with CHD at high risk for DD, without known genetic abnormality, and with ≥3 assessments using the Bayley Scales of Infant Development-III (BSID-III) were studied. Logistic regression was used to assess the impact of patient and clinical factors on cognitive, language, and motor score trajectories; classified as: “Average or Improved” if all scores were ≥ 85 (< 1SD below mean) or increased to ≥ 85 and never decreased; or “Abnormal” if all scores were < 85, fell to < 85 and never improved, or fluctuated above and below 85. Data on 131 children with 527 BSID-III assessments were analyzed. Subject age was 5.5–37.4 months. Overall, 56% had cognitive, language, and motor development in the average range. Delays occurred in single domains in 23%. Multiple domains were delayed in 21%. More cardiac surgeries, longer hospital stay, poorer linear growth, and tube feeding were associated with worse outcomes in all domains (p<0.05). In the multivariable model, need for tube feeding was a risk factor for having an abnormal developmental trajectory (OR = 5.1–7.9). Minority race and lack of private insurance had significant relationships with individual domains. Conclusions Longitudinal developmental surveillance identified early factors that can help quantify risk of DD over time. Strategies to improve modifiable factors and early therapeutic intervention can be targeted to children at highest risk.

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“…Abnormalities in the fetal circulation due to CHD disrupt oxygen and substrate delivery to the cerebral circulation, which further disrupt cerebral perfusion (14). In addition, alterations in the fetal circulation due to CHD have also been associated with blood flow abnormalities of the umbilical vessels (16–18). Evaluation of the cerebral-placental vascular bed in CHD using Doppler measures of the middle cerebral arteries, umbilical arteries and cerebro-placental ratio has revealed decreased resistance of blood flow in the cerebral arteries as well as significant abnormalities of the cerebro-placental ratio (19).…”

Section: Introductionmentioning

confidence: 99%

3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

et al. 2015

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Introduction Placental insufficiency remains a common cause of perinatal mortality and neurodevelopmental morbidity. Congenital heart disease (CHD) in the fetus and its relationship to placental function is unknown. This study explores placental health and its relationship to neonatal outcomes by comparing placental volumes in healthy pregnancies and pregnancies complicated by CHD using in vivo three-dimensional MRI studies. Methods In a prospective observational study, pregnant women greater than 18 weeks gestation with normal pregnancies or pregnancies complicated by CHD were recruited and underwent fetal MR imaging. The placenta was manually outlined and the volume was calculated in cm3. Brain volume was also calculated and clinical data were also collected. Relationships, including interactive effects, between placental and fetal growth, including brain growth, were evaluated using longitudinal multiple linear regression analysis. Results 135 women underwent fetal MRI between 18 and 39 weeks gestation (mean 31.6 ± 4.4). Placental volume increased exponentially with gestational age (p=0.041). Placental volume was positively associated with birth weight (p <0.001) and increased more steeply with birth weight in CHD-affected fetuses (p=0.046). Total brain and cerebral volumes were smaller in the CHD group (p<0.001), but brainstem volume (p<0.001) was larger. Placental volumes were not associated with brain volumes. Discussion Impaired placental growth in CHD is associated with gestational age and birth weight at delivery. Abnormalities in placental development may contribute to the significant morbidity in this high-risk population. Assessment of placental volume by MRI allows for in vivo assessments of placental development.

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Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow

Abstract: Objective Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain-sparing in placental insufficiency

Cited by 58 publications

References 20 publications

Assessment of Haemodynamic Remodeling in Fetal Aortic Coarctation Using a Lumped Model of the Circulation

Assessment of Haemodynamic Remodeling in Fetal Aortic Coarctation Using a Lumped Model of the Circulation

Risk Factors for Abnormal Developmental Trajectories in Young Children With Congenital Heart Disease

3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

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