Effect of fetal hemodynamics on growth in fetuses with single ventricle or transposition of the great arteries

Alsaied, Tarek; Tseng, Stephanie; King, Eileen; Hahn, E. L.; Divanović, Allison; Habli, Mounira; Cnota, James

doi:10.1002/uog.18936

Cited by 15 publications

(34 citation statements)

References 33 publications

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“…With progressive hypoxia as in cases of FGR, blood flow increases to compensate for the decrease in available oxygen (brain-sparing effect). 33,35 Our previous study showed no association of the MCA-PI with head circumference in any group. 34 Previous work showed reduced MCA-PI in HLHS suggesting a vasodilatory response in the cerebral vasculature as there is retrograde flow through the transverse arch and higher MCA-PI in non-HLHS SV suggests a higher cerebral vascular resistance.…”

Section: Discussionmentioning

confidence: 69%

“…34 Previous work showed reduced MCA-PI in HLHS suggesting a vasodilatory response in the cerebral vasculature as there is retrograde flow through the transverse arch and higher MCA-PI in non-HLHS SV suggests a higher cerebral vascular resistance. 33 Most of the fetuses in the non-HLHS SV group have right ventricular outflow tract obstruction and the majority of the CCO flows through the ascending aorta. The elevated resistance suggests a regulatory mechanism to control cerebral blood flow in this population.…”

Section: Discussionmentioning

confidence: 98%

“…8 A change in the UA-PI precedes any changes in the fetal heart rate patterns. 32,33 To account for these factors fetuses were matched for gestational age which was around 30 weeks of gestation, the fetal heart rate was normal in all fetuses, sampling was done in a consistent way at the mid-level free floating loop and the angle insonation was kept close to zero. 8 The etiology of FGR in fetuses with structurally normal heart is most often related to placental insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…This results in a reduction in MCA-PI although our study did not detect that difference which could be related to sample size. 33 There is no convincing evidence, however, that MCA-PI alone is useful in guiding clinical decisions about timing of delivery, although it may be useful as an adjunct to umbilical artery Doppler interrogation for predicting neonatal outcomes in FGR. 33 Most of the fetuses in the non-HLHS SV group have right ventricular outflow tract obstruction and the majority of the CCO flows through the ascending aorta.…”

Section: Discussionmentioning

confidence: 99%

“…31 Other factors that may affect interpretation of UA-PI include fetal gestational age, heart rate, fetal breathing, fetal movements, and technical aspects including the angle of insonation. 32,33 To account for these factors fetuses were matched for gestational age which was around 30 weeks of gestation, the fetal heart rate was normal in all fetuses, sampling was done in a consistent way at the mid-level free floating loop and the angle insonation was kept close to zero.…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic adaptation to suboptimal fetal growth in patients with single ventricle physiology

et al. 2018

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemodynamic adaptation to suboptimal fetal growth in patients with single ventricle physiology

et al. 2018

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Three‐Dimensional Volumetric Magnetic Resonance Imaging Detects Early Alterations of the Brain Growth in Fetuses With Congenital Heart Disease

Ren

Zhu

Dong

2021

Magnetic Resonance Imaging

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Background: Several published studies have shown alterations of brain development in third-trimester fetuses with congenital heart disease (CHD). However, little is known about the timing and pattern of altered brain development in fetuses with CHD. Purpose: To investigate the changes in the volume of intracranial structures in fetuses with CHD by three-dimensional (3D) volumetric magnetic resonance imaging (MRI) in the earlier stages of pregnancy (median gestational age [GA], 26 weeks). Study Type: Retrospective. Population: Forty women carrying a fetus with CHD (including 20 fetuses with GA <26 weeks) and 120 pregnant women carrying a healthy fetus (including 50 fetuses with GA <26 weeks). Field Strength/Sequence: Two-dimensional single-shot turbo spin echo sequence at 1.5 -T. Assessment: Three-dimensional volumetric parameters from slice-to-volume registered images, including cortical gray matter volume (GMV), subcortical brain tissue volume (SBV), intracranial cavity volume (ICV), lateral ventricles volume (VV), cerebellum, brainstem, and extra-cerebrospinal fluid (e-CSF) were quantified by manual segmentation from one primary and two secondary observers. Statistical Tests: Volumes were presented graphically with quadratic curve fitting. Scatterplots were produced mapping volumes against GA in normal and CHD fetuses. For GA <26 weeks, Z scores were calculated and Student's t-tests were conducted to compare volumes between the normal and CHD fetuses. Results: In fetuses with CHD GMV, SBV, cerebellum, and brainstem were significantly reduced (all P < 0.05) in early stages of pregnancy (GA <26 weeks), with differences becoming progressively greater with increasing GA. Compared with normal fetuses, e-CSF, e-CSF to ICV ratio, and VV were higher in fetuses with CHD (all P < 0.05). However, ICV volume and the GMV to SBV ratio were not significantly reduced in the CHD group (P = 0.94 and P = 0.13, respectively) during the middle gestation (GA <26 weeks). Data Conclusion: There appear to be alterations of brain development trajectory in CHD fetuses that can be detected by 3D volumetric MRI in the earlier stages of pregnancy. Level of Evidence: 4 Technical Efficacy: Stage 3

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Near‐Term Cerebroplacental Doppler, Heart Morphology, and Neonatal Biometry in Hypoplastic Left Heart Syndrome

Wójtowicz

Ochoda-Mazur

Mroczek

et al. 2021

J of Ultrasound Medicine

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Objectives To analyze near‐term cerebroplacental Doppler, heart morphology, and neonatal biometry in isolated hypoplastic left heart syndrome (HLHS) relative to healthy controls. Methods This retrospective study included 55 fetuses with HLHS (29 with mitral valve stenosis [MS]/aortic valve atresia [AA], 14 with MS/aortic valve stenosis, and 12 with mitral valve atresia [MA]/[AA]) diagnosed prenatally between 2010 and 2019 at 2 referral centers and 101 healthy controls. Ultrasound assessment included umbilical artery (UA), middle cerebral artery (MCA) pulsatility index (PI), and cerebroplacental ratio (CPR), with neonatal weight, length, head circumference (HC), Apgar score, and UA pH measured at birth. Results In total, 32.7% of HLHS fetuses had abnormal MCA‐PI and UA‐PI, and 38.2% had CPRs below the fifth percentile before birth. All tested Doppler parameters differed from those of the healthy controls (P ≤ .01). Birth weight and length were comparable between HLHS and control fetuses, whereas birth HCs were smaller in the HLHS group than in the control group (P = .018). In both groups, increased UA‐PI correlated with lower birth weight, but only HLHS fetuses with UA‐PI > the 95th percentile had a lower median HC at birth than those with normal UA‐PI (P = .045). The median UA‐PI percentile was higher in fetuses with MA than in fetuses with MS (P = .015). The ascending aortic diameter correlated with birth weight (P = .036) and birth length (P = .039). Conclusion Abnormal cerebroplacental hemodynamics are evident in a high percentage of near‐term fetuses with HLHS, and increased placental resistance may contribute to birth weight and HC. Moreover, heart morphology may impact placental circulation and neonatal biometry.

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Effect of fetal hemodynamics on growth in fetuses with single ventricle or transposition of the great arteries

Cited by 15 publications

References 33 publications

Hemodynamic adaptation to suboptimal fetal growth in patients with single ventricle physiology

Hemodynamic adaptation to suboptimal fetal growth in patients with single ventricle physiology

Three‐Dimensional Volumetric Magnetic Resonance Imaging Detects Early Alterations of the Brain Growth in Fetuses With Congenital Heart Disease

Near‐Term Cerebroplacental Doppler, Heart Morphology, and Neonatal Biometry in Hypoplastic Left Heart Syndrome

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