Doppler indices of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery <i>in utero</i>: is there a brain‐sparing effect?

Berg, Christoph; Gembruch, Oliver; Gembruch, U; Geipel, A.

doi:10.1002/uog.7474

Cited by 79 publications

(102 citation statements)

References 28 publications

(45 reference statements)

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“…Alterations in cerebral blood flow called the 'brain-sparing effect' were observed more frequently in the CHD group than in the normal group; these results are consistent with those of previous studies [6][7][8][9][10][11] . Donofrio et al [6] stated that the mixing of oxygenated and deoxygenated blood in a structurally abnormal heart might trigger this phenomenon.…”

Section: Discussionsupporting

confidence: 82%

“…Corresponding to previous reports, all fetuses with hypoplastic left-heart syndrome showed MCA RI ! 10th percentile [6,8,10,11] . Furthermore, most of the growth parameters during the fetal period and at birth were lower in the CHD group than in the control group.…”

Section: Discussionmentioning

confidence: 99%

“…This redistribution of blood flow to the brain, which is referred to as 'brain-sparing effect' is detected by Doppler measurement of the lower middle cerebral artery (MCA) resistance index (RI) and higher umbilical artery (UA) RI [6,14] . In fetuses with CHD, there are several reports regarding the Doppler study [6][7][8][9][10][11] , and only two reports mention the association between fetal head circumference and Doppler examination [6,11] . The purpose of this study was to investigate the relationship between the fetal growth and cerebrovascular resistance in fetuses with CHD.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Fetal Circulation Associated with Congenital Heart Disease and Their Effects on Fetal Growth

Itsukaichi

Kikuchi²,

Yoshihara³

et al. 2011

Fetal Diagn Ther

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Objective: Our aim was to investigate the association between fetal growth and cerebrovascular resistance in fetuses with congenital heart disease (CHD). Methods: Fetal echocardiography was performed to measure the biparietal diameter, abdominal circumference, femur length, estimated fetal body weight, middle cerebral artery (MCA) resistance index (RI) and umbilical artery (UA) RI in 44 fetuses with CHD and 140 normal fetuses at a gestational age of 28–34 weeks. Results: Fetuses with CHD exhibited significantly lower values for femur length, estimated fetal body weight at the third trimester, body weight, length, and chest circumference at birth than normal controls. The percentages of fetuses showing MCA RI values <10th percentile and UA RI values >90th percentile were significantly higher in the CHD group than in the control group. However, there were no significant differences in any biometric parameters measured between cases with MCA RI values ≧10th percentile and values <10th percentile. Conclusions: Growth restriction and blood flow changes were observed significantly more frequently in fetuses with CHD than in those without CHD. Further studies are necessary to clarify the association between fetal growth and dynamic changes in fetal circulation.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Fetal Circulation Associated with Congenital Heart Disease and Their Effects on Fetal Growth

Itsukaichi

Kikuchi²,

Yoshihara³

et al. 2011

Fetal Diagn Ther

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“…Although the available UA resistance index results did not identify definitive placental insufficiency, vascular pathology in the placenta could lead to reduced substrate delivery that is not detectable by current clinical testing. It is also possible that, despite oxygen delivery via the maternal-fetal circulation and compensatory mechanisms within the central nervous system (23), the fetus with HLHS is subject to metabolic inefficiencies of hypoxia, particularly in the brain (24). Cerebral hypoxia is one potential explanation for the well-described reduction in head and brain size associated with HLHS and may contribute to subsequent adverse clinical outcomes (25).…”

Section: Hlhs Fetal Somatic Growth Trajectorymentioning

confidence: 99%

Somatic growth trajectory in the fetus with hypoplastic left heart syndrome

et al. 2013

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Background: Fetal growth abnormalities in hypoplastic left heart syndrome (HLHS) have been documented primarily by birth measurements. Fetal growth trajectory has not been described. We hypothesized that fetal growth trajectory declines across late gestation in this population. Methods: Infants with a prenatal diagnosis of HLHS and no history of prematurity or a genetic syndrome were identified. Fetal ultrasound measurements and birth anthropometrics were obtained from clinical records. z-Scores for estimated fetal weight (EFWz) and birth weight (BWTz) were compared. BWTz for three neonatal standards were compared. results: Paired fetal and neonatal data were identified in 33 cases of HLHS. Mean gestational age at ultrasound and birth were 27 and 38 wk, respectively. BWTz was lower than EFWz by a mean of 0.82 (SD: 0.72, P < 0.0001), with 64% of subjects demonstrating a decrease in z-score of >0.5. Umbilical artery (UA) Doppler found no evidence of significant placental insufficiency. Modest differences in BWTz were seen across BWT standards in this cohort. conclusion: The majority of fetuses with HLHS demonstrate decreased growth velocity during later pregnancy, suggesting growth abnormalities manifest in utero. The potential relationship to future clinical outcomes warrants further study.

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“…From a clinical perspective, if reduced placental blood supply is involved in brain injury in CHD, those cardiac defects causing the most severe reductions in the mix of oxygenated blood to the brain should be associated with a higher risk of neurological injury [16]. Thus, several studies have reported more pronounced changes in head biometry and brain Doppler parameters in cases with hypoplastic left heart syndrome (HLHS) or transposition of the great arteries (TGA) in comparison with right heart defects [17,18,19]. In a previous study, Limperopoulos et al [11] reported that some types of CHD were independently associated with more pronounced changes in MRI brain total volume.…”

Section: Introductionmentioning

confidence: 99%

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

et al. 2015

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Objectives: We evaluated the hypothesis that in fetuses with congenital heart disease (CHD) there is a correlation between the expected pattern of in utero brain blood supply and the severity of neurodevelopmental impairment. Methods: A total of 58 fetuses with CHD and 58 controls underwent a Doppler ultrasound and fetal MRI at 36-38 weeks. Fetuses with CHD were divided into two functional classes: class A with an expected severe reduction in oxygenated brain blood supply (left outflow tract obstruction and transposition of great vessels) and class B with theoretically near-normal or mildly impaired oxygenated brain blood supply (other CHD). Head biometry and cerebroplacental Doppler were assessed by ultrasound, and brain volumetry, cortical development and metabolism by MRI. Results: Both class A and B CHD fetuses had significant differences in head biometry, brain perfusion, cortical development and brain metabolism compared with controls. However, there was a significant linear tendency for head biometry, cerebral Doppler, volumes, cortical sulcation and metabolic ratios across the three clinical groups, with signs of more severe brain alterations in type A CHD fetuses. Conclusions: All fetuses with CHD showed significant brain developmental changes, but differences were more pronounced in CHD associated with an expected severe reduction in oxygenated blood supply to the brain.

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Doppler indices of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery in utero: is there a brain‐sparing effect?

Abstract: K E Y W O R D S:

Cited by 79 publications

References 28 publications

Changes in Fetal Circulation Associated with Congenital Heart Disease and Their Effects on Fetal Growth

Changes in Fetal Circulation Associated with Congenital Heart Disease and Their Effects on Fetal Growth

Somatic growth trajectory in the fetus with hypoplastic left heart syndrome

Severity of Fetal Brain Abnormalities in Congenital Heart Disease in Relation to the Main Expected Pattern of in utero Brain Blood Supply

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