The cerebroplacental Doppler ratio predicts postnatal outcome in fetuses with congenital heart block

Abstract

Objective: Autoimmune-mediated congenital complete heart block (CCHB) is associated with significant perinatal morbidity and mortality, and prenatal monitoring of these fetuses is a significant challenge. The cerebroplacental Doppler ratio (CPR), defined as the ratio of the middle cerebral artery pulsatility index (MCA-PI) to the umbilical artery pulsatility index (UA-PI), is predictive of perinatal outcome in growth-restricted fetuses. This study tests the hypothesis that the CPR would be useful in monitoring fetal well-being in fetuses with CCHB.Study Design: We reviewed data on all patients diagnosed prenatally with autoimmune-mediated CCHB at our institution over the past 2 years. The fetal echocardiograms from each patient were analyzed for: CPR, UA-PI, MCA-PI, cardiothoracic ratio, degree of tricuspid regurgitation, ventricular function and presence of effusions. We compared hemodynamic data from the fetal echocardiogram before delivery in patients who required urgent pacemaker placement postnatally to those patients that did not require an urgent pacemaker.Result: Five patients with autoimmune-mediated CCHB were identified, and two patients required urgent pacemaker placement. The CPR before delivery was significantly lower in the patients who required urgent pacemaker placement (0.97±0.06 versus 1.45±0.03; P ¼ 0.003), but there was no difference in other fetal echocardiographic markers between groups. Both patients requiring urgent pacemaker placement had a CPR less than 1.08. Conclusion:The CPR is predictive of postnatal outcome in fetuses with CCHB and is useful in prenatal monitoring of these patients.

Reduced combined ventricular output and increased oxygen extraction fraction in a fetus with complete heart block demonstrated by MRI

“…However, the cerebroplacental ratio (CPR), which overcomes this problem because it is a ratio of middle cerebral artery and umbilical artery (UA) pulsatility index (PI), has been shown to have prognostic value in the setting of CHB 15 . The Doppler findings therefore support a hypothesis that the fetal growth restriction had a cardiovascular etiology in this case, in which the UA PI was high and middle cerebral artery PI was in the normal range resulting in a CPR below the 5th percentile throughout the pregnancy.…”

Échographie et Doppler fœtaux dans le bloc auriculoventriculaire congénital d’origine immunologique

“…Fleming et al [63] ont récemment rapporté que l'évaluation du rapport cérébroplacentaire à l'aide du Doppler (rapport entre l'indice de pulsatilité de l'artère cérébrale moyenne du foetus et l'indice de pulsatilité de l'artère ombilicale, qui est un indicateur de la redistribution du débit cardiaque et un élément prédictif du pronostic périnatal en cas de retard de croissance intra-utérin [64]) pourrait être un élément prédictif du pronostic post-natal en cas de BAV. Dans leur série de cinq cas, ce rapport était en période prénatale significativement plus bas chez les foetus ayant nécessité une électrostimulation cardiaque en urgence à la naissance (0,97 AE 0,06 contre 1,45 AE 0,03, p = 0,003).…”

Prediction of outcome in fetal autoimmune complete heart block

“…7 Of note, in a single center experience, a lower CPR in fetuses with autoimmune CAVB was found to be predictive of postnatal hemodynamic compromise but was limited by small sample size. 8 Our aim was to evaluate the utility of fetal echocardiography including the use of the CVP score and its individual components, including arterial Doppler of the MCA and calculation of CPR in the serial surveillance of fetuses with anti-SSA and/or anti-SSB mediated CAVB as predictors of fetal course and perinatal mortality.…”

“…range[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Two fetuses only had one study in CAVB, including the one termination of pregnancy.…”