Head Biometry in Fetuses with Isolated Congenital Heart Disease

Abstract

Purpose Altered cerebral hemodynamics are involved in changes in head biometry in fetuses with congenital heart disease (CHD). We compared head growth in different CHD groups with published normative values and investigated whether CHD groups differ from each other in terms of head circumference (HC) development over gestational age (GA). Materials and Methods Retrospective cohort study consisting of 248 CHD fetuses. Subgroups were generated according to the expected ascending aorta oxygen saturation: Low placental blood content (BC) and therefore low oxygen delivery to the brain (group 1: n = 108), intermediate placental and systemic BC due to intracardiac mixing of blood (group 2: n = 103), high placental BC (group 3: n = 13) and low placental BC and low oxygen delivery to the brain without mixing of blood (group 4: n = 24). Furthermore, group 1 was divided into antegrade (n = 34) and retrograde (n = 74) flow through the aortic arch. Comparisons were made at a GA of 22, 30 and 38 weeks. Results Estimated values of zHC (z-score transformed) were not significantly different between the four CHD groups at the three time points in gestation (all p > 0.05). Within group 1 fetuses with retrograde aortic arch flow showed a significant negative association between HC and GA compared to reference values (b = –0.054, p < 0.001) and had significantly lower zHC values at 38 weeks (–0.836) compared to fetuses with antegrade flow (0.366, p = 0.009). Conclusion Our data do not confirm that CHD fetuses in general have a significantly smaller HC. HC becomes smaller throughout gestation depending on the direction of aortic arch flow.

Cerebroplacental and Uterine Doppler Indices in Pregnancies Complicated by Congenital Heart Disease of the Fetus

“…Confirmation of prenatal diagnosis was achieved in all liveborn cases postnatally. The cohort was analyzed previously describing head biometry in CHD fetuses, and fetomaternal data were described before [15].…”

“…The presence of major CHD was the main inclusion criterion. The exclusion criteria were as previously described for the same CHD cohort [15]. Prenatal diagnosis of CHD was confirmed by postnatal echocardiography or autopsy in the case of termination of pregnancy.…”

“…CHD subgroups were generated according to their postnatal diagnosis, which was made by echocardiography or autopsy. The influence of oxygen delivery and blood flow to the brain on fetal hemodynamics was examined in CHD subgroups according to the expected ascending aorta oxygen saturation as previously described for the same CHD cohort [15] (▶ Table 1):…”

“…The method of cluster generating is similar to Masoller et al [11] and is based on physiologic assumptions in the animal model [24]. The cohort was analyzed previously describing head biometry in CHD fetuses [15].…”

“…In addition, a significant proportion of newborns with CHD exhibit cerebral abnormalities in magnetic resonance imaging and have a smaller head size [4, 11 -14]. Our own work revealed that in particular CHD fetuses with severe left heart obstruction and retrograde aortic arch flow leading to low oxygen saturation in the ascending aorta show restricted HC growth during pregnancy [15]. These pathological processes described in gestation may have an impact on impaired neurodevelopment in later childhood.…”