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

Abstract

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.

Maternal‐fetal comorbidities and obstetrical outcomes of fetal single ventricle cardiac defects: 10 years' experience with a multidisciplinary management protocol at a single center

“…These findings suggest that the FGR in SVCD is multifactorial. This is supported by the findings of small postnatal head circumference in HLHS subjects with elevated UA Doppler studies 12,31 …”

“…This is supported by the findings of small postnatal head circumference in HLHS subjects with elevated UA Doppler studies. 12,31 There are several implications for future research that come from our study and others. The fetal and placental circulation of blood flow in fetuses with SVCD is complex and not well understood.…”

“…8,9 Emerging evidence suggests that an impaired maternal-fetal environment, including gestational hypertension, preeclampsia and gestational diabetes, has been associated with preterm birth, low birthweight, greater risk of postnatal death, longer hospital stay and lower survival at 36 months of age. 10,11 These findings, along with elevated umbilical artery (UA) Doppler velocimetry in HLHS compared with controls 12 suggest that uteroplacental insufficiency is the common denominator in the multiple causes creating an adverse maternal/fetal environment. Understanding the maternal-fetalplacental environment may provide further understanding and insight for treatments related to modifiable risk factors.…”