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

Abstract

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.

Corpus callosum size by neurosonography in fetuses with congenital heart defect and relationship with expected pattern of brain oxygen supply

“…First, we recognize that the CHD classification according to expected cerebral oxygen delivery used in this study has not been validated extensively, and larger studies are required to analyze further the association of these CHD types with neurodevelopment. However, this classification and similar ones have been used before 6,7,50,51 to differentiate the main patterns of oxygenated blood supply to the brain during the prenatal period 8 . Second, postnatal neurodevelopment was not evaluated in our series, and therefore, the morphometric changes identified in the CC cannot be correlated directly with neurological outcomes.…”

Cerebral Blood Flow Monitoring in High-Risk Fetal and Neonatal Populations

“…In fetuses with CHD, there is mounting evidence that brain development is disrupted prenatally with lagging brain growth (38,124,125) and estimated growth delay of ∼1 month (126)(127)(128). This observation has spurred significant interest in CBF monitoring in this population.…”

Brain Oxygen Perfusion and Oxidative Stress Biomarkers in Fetuses with Congenital Heart Disease—A Retrospective, Case-Control Pilot Study

“…For decades, the relationship between expected brain perfusion in CHD and brain development has been thoroughly studied [ 9 , 10 , 24 , 25 , 26 , 27 ].…”

“…In the same line, Everwijn and colleagues reported that only TGA fetuses present a delay in brain maturation. In their study, fetuses with HLHS did not show significantly less mature brains [ 24 ]. All these results could support the differences that we have found between TGA and HLHS patients in our cohort.…”