Middle cerebral artery Doppler in fetuses with transposition of the great arteries

Jouannic, Jean‐Marie; Benachi, Alexandra; Bonnet, Damien; Fermont, L; Bidois, J. Le; Dumez, Yves; Dommergues, Marc

doi:10.1046/j.1469-0705.2002.00756.x

Cited by 51 publications

(53 citation statements)

References 17 publications

(14 reference statements)

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“…The relatively small number of patients in the non-mixing group prevented demonstrating statistical significance. Jouannic et al [21] found the lower PIs (p ! 0.001) observed in the MCA of fetuses with transposition of the great arteries was an indicator of hypoxemia and/or hypercapnia restricted to areas perfused by the preisthmus aorta.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Shaohui

Peng

et al. 2009

Fetal Diagn Ther

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Objective: The aim of this study was to determine whether the type of congenital heart disease (CHD) or heart function influence fetal cerebrovascular blood flow dynamics. Methods: Doppler flow velocimetry was performed in the umbilical artery (UA) and middle cerebral artery (MCA), and the ratio of the UA pulsatility index (PI) to the MCA PI (U/C PI) was determined in 45 fetuses with CHD at 20–40 weeks’ gestational age. The control group consisted of 275 healthy fetuses matched for gestational age. Individual PI measurements were converted into Z-scores for statistical analysis. Results: Fetuses with CHD (n = 45) had an increased UA PI (p = 0.001) and U/C PI (p < 0.001) when compared to controls. There was no significant difference in the MCA PI between fetuses with CHD (n = 45) and controls (n = 275), while fetuses with CHD complicated by congestive heart failure (CHF) (n = 10) had a decreased MCA PI (p < 0.001) compared to controls. Conclusions: The lower PIs observed in the MCA of fetuses with CHD complicated by CHF represents a marker of cerebral vasodilation that is due to cerebral hypoxemia and limiting perfusion. The heart function and type of CHD have an impact on fetal cerebrovascular blood flow distribution and this may contribute to the cause of abnormal neurologic development in these fetuses.

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Section: Discussionmentioning

confidence: 99%

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Shaohui

Peng

et al. 2009

Fetal Diagn Ther

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“…30,124,125 Alterations in cerebral blood flow have been noted in fetuses with complex CHD. 67,126,127 Several studies have noted that third-trimester fetuses diagnosed with CHD had impaired volumetric brain growth. 128,129 Notably, a study that assessed brain maturation by magnetic resonance imaging (MRI) in a cohort of full-term neonates with CHD after birth revealed an average brain maturation of only 35 weeks' gestation.…”

Section: Significant Abnormalities On Neuroimaging or Microcephalymentioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Marino¹,

Lipkin²,

Newburger³

et al. 2012

Circulation

1,305

1,156

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Background— The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. Methods and Results— A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Conclusions— Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

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“…Thus, although the focus of neurodevelopmental studies was initially placed on the operative time period, preoperative brain abnormalities and early postoperative hemodynamic instability are also likely to play a significant role in later neurodevelopmental impairment [12][13][14][15][16][17]. The evidence for preoperative, pre-existing brain abnormalities, including strong evidence for impaired cerebral development, come from fetal and preoperative neonatal brain magnetic resonance imaging (MRI) studies [15][16][17][18][19][20][21][22][23][24][25][26]. However, MRI is often impractical in the preoperative time period due to patient instability, especially in those with more complex CHD who are at higher risk.…”

Section: Introductionmentioning

confidence: 99%

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

Dehaes

Cheng

Buckley

et al. 2015

Biomed. Opt. Express

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Abstract:Congenital heart disease (CHD) patients are at risk for neurodevelopmental delay. The etiology of these delays is unclear, but abnormal prenatal cerebral maturation and postoperative hemodynamic instability likely play a role. A better understanding of these factors is needed to improve neurodevelopmental outcome. In this study, we used bedside frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) to assess cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle (SV) CHD undergoing surgery and compared them to controls. Our goals were 1) to compare cerebral hemodynamics between unanesthetized SV and healthy neonates, and 2) to determine if FDNIRS-DCS could detect alterations in cerebral hemodynamics beyond cerebral hemoglobin oxygen saturation (SO 2 ). Eleven SV neonates were recruited and compared to 13 controls. Preoperatively, SV patients showed decreased cerebral blood flow (CBF i ), cerebral oxygen metabolism (CMRO 2i ) and SO 2 ; and increased oxygen extraction fraction (OEF) compared to controls. Compared to preoperative values, unstable postoperative SV patients had decreased CMRO 2i and CBF i , which returned to baseline when stable. However, SO 2 showed no difference between unstable and stable states. Preoperative SV neonates are flow-limited and show signs of impaired cerebral development compared to controls. FDNIRS-DCS shows potential to improve assessment of cerebral development and postoperative hemodynamics compared to SO 2 alone. References and links 1. J. I. E. Hoffman and S. Kaplan, "The incidence of congenital heart disease," J. Am. Coll. Cardiol. 39, 1890-1900 A. Rappaport, and D. Wypij, "Randomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery," J. Thorac. Cardiovasc. Surg. 135, 347-54, 354.e1-4 (2008).

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Middle cerebral artery Doppler in fetuses with transposition of the great arteries

Cited by 51 publications

References 17 publications

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Cerebrovascular Blood Flow Dynamic Changes in Fetuses with Congenital Heart Disease

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology

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