Association between fetal growth, cerebral blood flow and neurodevelopmental outcome in univentricular fetuses

Hahn, E. L.; Szwast, Anita; Cnota, James; Levine, Jami C.; Fifer, Carlen G.; Jaeggi, Edgar; Andrews, H.; Williams, Ismée A.

doi:10.1002/uog.14881

Cited by 50 publications

(84 citation statements)

References 19 publications

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“…This finding has also been reported in an MRI study in TOF fetuses [22]. The hypothesis that the specific type of heart defect, such as HLHS and TOF, might play an important role in fetal cerebral development has been suggested in an increasing number of studies [10, 13, 26, 28, 29]. When specific types of CHD are studied in depth, it was furthermore found that neonates with minor CHD such as ventricular septal defects also demonstrate altered brain growth [30], which was the rationale for us to include minor CHD in our current study.…”

Section: Discussionsupporting

confidence: 54%

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Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

et al. 2019

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Objective: The aim of our study is to explore whether the cerebral growth is delayed in fetuses with congenital heart defects (CHD) in the second and early third trimester. Methods: A prospective cohort study was conducted in 77 CHD cases, with 75 healthy controls. 3D cerebral volume acquisition was performed sequentially. The volumes of the fetal hemicerebrum and extracerebral fluid were compared by linear regression analysis, and the Sylvian fissure was measured. Results: Between 19 and 32 weeks of gestation, 158 measurements in cases and 183 measurements in controls were performed (mean 2.2/subject). The volume growth of the hemicerebrum (R² = 0.95 vs. 0.95; p = 0.9) and the extracerebral fluid (R² = 0.84 vs. 0.82, p = 0.9) were similar. Fetuses with abnormal oxygen delivery to the brain have a slightly smaller brain at 20 weeks of gestation (p = 0.02), but this difference disappeared with advancing gestation. CHD cases demonstrated a slightly shallower Sylvian fissure (mean ratio 0.146 vs. 0.153; p = 0.004). Conclusions: Our study shows no differences in cerebral growth, studied in an unselected cohort, with successive cases of isolated CHD. Even in the severest CHD cases, cerebral size is similar in the early third trimester. The cause and meaning of a shallower Sylvian fissure is unclear; possibly, it is a marker for delayed cerebral maturation or it might be an expression of decreasing amount of extracerebral fluid.

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Section: Discussionsupporting

confidence: 54%

“…The prenatal studies are, however, dominated by a series of severe CHD and left-sided CHD [13, 16, 17], and some studies also included cases with non-isolated CHD [18, 19]. The reported variables, such as head circumference and flow indices, are very heterogeneous and were assessed at different gestational ages (GAs) [15].…”

Section: Introductionmentioning

confidence: 99%

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

et al. 2019

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“…Reduced fetal CVR was initially shown to be associated with lower cognitive scores at 18 months of age in a small cohort of mixed complex CHD 96 . However, two studies with larger and more homogeneous populations of univentricular fetuses demonstrated that decreased CVR, determined by the middle cerebral artery pulsality index, is associated with higher neurodevelopmental scores at 14 months of age determined by the Pyschomotor Development Index 39, 97 . Together, these clinical studies indicate that hemodynamics should be carefully monitored during fetal development and that optimizing cerebral oxygen delivery may improve neurodevelopmental outcomes in specific CHDs.…”

Section: Risk Factors Associated With Chdmentioning

confidence: 98%

Neurodevelopmental Abnormalities and Congenital Heart Disease

Morton

Ishibashi

Jonas

2017

Circulation Research

154

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In the past two decades it has become evident that individuals born with congenital heart disease (CHD) are at risk of developing life-long neurological deficits. Multifactorial risk factors contributing to neurodevelopmental abnormalities associated with CHD have been identified; however the underlying etiologies remain largely unknown and efforts to address this issue have only recently begun. There has been a dramatic shift in focus from newly acquired brain injuries associated with corrective and palliative heart surgery to antenatal and preoperative factors governing altered brain maturation in CHD. In this review, we describe key time windows of development during which the immature brain is vulnerable to injury. Special emphasis is placed on the dynamic nature of cellular events and how CHD may adversely impact the cellular units and networks necessary for proper cognitive and motor function. In addition, we describe current gaps in knowledge and offer perspectives about what can be done to improve our understanding of neurological deficits in CHD. Ultimately, a multidisciplinary approach will be essential in order to prevent or improve adverse neurodevelopmental outcomes in individuals surviving CHD.

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“…It has been assumed that prolonged periods of this autoregulation may lead to delayed maturation of the fetal oligodendrocytes, reduced myelinization, and increased vulnerability of the brain (25–28). However, in fetuses with single ventricular heart, decreased cerebrovascular resistance has been found associated with higher PDI scores at the age of 14 months (29, 30). It remains unclear whether fetal cerebral blood flow alterations predict ND outcomes later in childhood.…”

Section: Encephalopathy Of Chd: Delayed Maturation Injury and Neuromentioning

confidence: 99%

Factors Influencing Neurodevelopment after Cardiac Surgery during Infancy

Hövels-Gürich

2016

Front. Pediatr.

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Short- and long-term neurodevelopmental (ND) disabilities with negative impact on psychosocial and academic performance, quality of life, and independence in adulthood are known to be the most common sequelae for surviving children after surgery for congenital heart disease (CHD). This article reviews influences and risk factors for ND impairment. For a long time, the search for independent risk factors was focused on the perioperative period and modalities of cardiopulmonary bypass (CPB). CPB operations to ensure intraoperative vital organ perfusion and oxygen supply with or without circulatory arrest or regional cerebral perfusion bear specific risks. Examples of such risks are embolization, deep hypothermia, flow rate, hemodilution, blood gas management, postoperative hyperthermia, systemic inflammatory response, and capillary leak syndrome. However, influences of these procedure-specific risk factors on ND outcome have not been found as strong as expected. Furthermore, modifications have not been found to support the effectiveness of the currently used neuroprotective strategies. Postoperative factors, such as need for extracorporal membrane oxygenation or assist device support and duration of hospital stay, significantly influence ND parameters. On the other hand, the so-called “innate,” less modifiable patient-specific risk factors have been found to exert significant influences on ND outcomes. Examples are type and severity of CHD, genetic or syndromic abnormalities, as well as prematurity and low birth weight. Structural and hemodynamic characteristics of different CHDs are assumed to result in impaired brain growth and delayed maturation with respect to the white matter. Beginning in the fetal period, this so-called “encephalopathy of CHD” is suggested a major innate risk factor for pre-, peri-, and postoperative additional hypoxic or ischemic brain injury and subsequent ND impairment. Furthermore, MRI studies on brain volume, structure, and function in adolescents have been found correlated with cognitive, motor, and executive dysfunctions. Finally, family and environmental factors independently moderate against ND outcomes. In conclusion, the different mediating factors may exert independent effects on ND and interactive influences. Implications for the future comprise modifying clinical risk factors, such as perioperative cerebral oxygen delivery, conducting brain MRI studies in correlation to ND outcomes, and extending psychosocial interventions leading to adequate resilience.

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Association between fetal growth, cerebral blood flow and neurodevelopmental outcome in univentricular fetuses

Cited by 50 publications

References 19 publications

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

Fetuses with Isolated Congenital Heart Defects Show Normal Cerebral and Extracerebral Fluid Volume Growth: A 3D Sonographic Study in the Second and Third Trimester

Neurodevelopmental Abnormalities and Congenital Heart Disease

Factors Influencing Neurodevelopment after Cardiac Surgery during Infancy

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