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Evidence of second trimester changes in head biometry and brain perfusion in fetuses with congenital heart disease.
MedLine Citation:
PMID:  24687311     Owner:  NLM     Status:  Publisher    
OBJECTIVES: The aim of our study was to evaluate the association of CHD on head biometry and cerebrovascular blood flow dynamics at the time of diagnosis in the second trimester of pregnancy.
MATERIAL AND METHODS: 95 consecutive fetuses diagnosed with CHD. At the time of diagnosis of CHD, we assessed fetal biometry and brain perfusion by middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR) and Fractional Moving Blood Volume (FMBV). The results were compared with 95 normal fetuses matched for gestational age (GA).
RESULTS: Median gestational age at diagnosis was 22.3 weeks (range 20 - 23.5 weeks). Fetuses with CHD showed significantly lower MCA-PI and CPR Z-scores (-0.23 vs 0.34 and -0.37 vs 0.30; p < 0.001, respectively) and higher FMBV Z-scores (2.35 vs 0.15; p < 0.001). FMBV >95th centile was observed in 81.1% of cases as compared with 10.5% in controls (p < 0.001). Moreover, cases showed significantly smaller biparietal diameter (BPD) and head circumference (HC) Z-scores (-1.61 vs -0.43 and -0.89 vs 0.09; p < 0.001, respectively) and a higher proportion of BPD and HC measurements below the 5(th) percentile compared with controls (51.6% vs 13.7% and 26.3% vs 4.2%; p < 0.001, respectively). These findings were more pronounced in those CHD with compromised oxygenated blood delivery to the brain, such as left outflow tract obstruction and transposition of the great arteries.
CONCLUSIONS: A high proportion of fetuses with CHD have smaller head and increased brain perfusion already in the second trimester, suggesting an early onset of the mechanisms leading to poorer neurodevelopment later in life.
N Masoller; J M Martínez; O Gómez; M Bennasar; F Crispi; M Sanz; G Egaña-Ugrinovic; J Bartrons; B Puerto; E Gratacós
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-3-29
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:  Ultrasound Obstet Gynecol     Publication Date:  2014 Mar 
Date Detail:
Created Date:  2014-4-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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This article is protected by copyright. All rights reserved.
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