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Comparative Analysis of Cerebrovascular Resistance in the Fetus with Single Ventricle Congenital Heart Disease.
MedLine Citation:
PMID:  22407644     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives: We sought to determine whether the presence or absence of aortic obstruction impacts cerebrovascular resistance in fetuses with single ventricle (SV) congenital heart disease (CHD). Methods: Pulsatility indices (PI) were recorded for the middle cerebral artery (MCA) and umbilical artery (UA) from 18 to 40 weeks gestation in 59 fetuses (163 studies) with SV CHD with unobstructed aortic flow, yet decreased pulmonary flow, 72 fetuses (170 studies) with obstructed aortic flow, hypoplastic left heart syndrome (HLHS), and 92 normal fetuses (92 studies). Cerebroplacental resistance (CPR) was calculated as the MCA PI/UA PI. Z-scores were generated for the MCA and UA PI in order to make comparisons independent of gestational age. Statistical analysis was performed via one-way ANOVA with post-hoc testing. Trends in these variables over the course of gestation were assessed with linear regression and univariate analysis of variance. Significance was set at p= 0.05. Results: The MCA PI and CPR were significantly lower in SV fetuses with aortic obstruction compared to SV fetuses with pulmonic obstruction and compared to normals. Moreover, the MCA PI dropped significantly for SV fetuses with aortic obstruction over the course of gestation. In contrast, the MCA PI was higher over the course of gestation in SV fetuses with pulmonic obstruction compared to normals. Conclusions: In fetuses with SV CHD, cerebrovascular resistance varies substantially between fetuses with and without aortic obstruction. Compared to normals, cerebrovascular resistance is decreased in SV fetuses with aortic obstruction, yet increased in SV fetuses with pulmonic obstruction. In fetuses with SV physiology, inherent differences in cerebral blood flow may underlie postnatal neurodevelopmental outcomes. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Anita Szwast; Zhiyun Tian; Margaret McCann; Debbra Soffer; Jack Rychik
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-9
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
The Fetal Heart Program at the Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Department of Pediatrics, Division of Cardiology, Philadelphia, PA, USA. szwast@email.chop.edu.
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