Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow
ABSTRACT Objective Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease o...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2013-09, Vol.42 (3), p.294-299 |
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| creator | Yamamoto, Y. Khoo, N. S. Brooks, P. A. Savard, W. Hirose, A. Hornberger, L. K. |
| description | ABSTRACT
Objective
Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA‐PI and head growth.
Methods
We retrospectively reviewed fetal echocardiograms of pregnancies complicated by fetal hypoplastic left heart syndrome (HLHS; n = 42) with and without anatomic coarctation (n = 28 and n = 10, respectively), isolated severe aortic coarctation (n = 21), D‐transposition of the great arteries (TGA; n = 11) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (POTO; n = 15), comparing observations with gestational age‐matched controls (n = 89). No fetus had major extracardiac pathology or aneuploidy. MCA and umbilical artery (UA) PI, the cerebral placental ratio (CPR = MCA‐PI/ UA‐PI) and neonatal head circumference were obtained and expressed as Z‐scores.
Results
Lower MCA‐PI, higher UA‐PI and lower CPR were observed in fetal HLHS and isolated coarctation with reversed arch flow (n = 6) (P |
| doi_str_mv | 10.1002/uog.12448 |
| format | Article |
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Objective
Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA‐PI and head growth.
Methods
We retrospectively reviewed fetal echocardiograms of pregnancies complicated by fetal hypoplastic left heart syndrome (HLHS; n = 42) with and without anatomic coarctation (n = 28 and n = 10, respectively), isolated severe aortic coarctation (n = 21), D‐transposition of the great arteries (TGA; n = 11) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (POTO; n = 15), comparing observations with gestational age‐matched controls (n = 89). No fetus had major extracardiac pathology or aneuploidy. MCA and umbilical artery (UA) PI, the cerebral placental ratio (CPR = MCA‐PI/ UA‐PI) and neonatal head circumference were obtained and expressed as Z‐scores.
Results
Lower MCA‐PI, higher UA‐PI and lower CPR were observed in fetal HLHS and isolated coarctation with reversed arch flow (n = 6) (P < 0.001) but not TGA, POTO or isolated coarctation with antegrade arch flow (n = 15) compared with controls. No difference was found between HLHS with anatomical coarctation and those without; however, MCA‐PI correlated positively with neonatal head circumference in HLHS with reversed distal arch flow (r = 0.33, P < 0.05).
Conclusions
Severe left heart obstruction with reversed aortic arch flow is associated with altered fetal cerebral blood flow, and in these conditions, MCA‐PI positively correlates with head growth. Anatomical arch obstruction itself may not be a contributing factor to altered MCA flow in fetal HLHS. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2013:42:255–256</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.12448</identifier><identifier>PMID: 23456797</identifier><identifier>CODEN: UOGYFJ</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Aneuploidy ; Aorta, Thoracic - pathology ; Aortic Coarctation - diagnostic imaging ; Aortic Coarctation - pathology ; brain sparing ; Cerebrovascular Circulation - physiology ; coarctation ; Echocardiography ; Female ; Fetal Development - physiology ; Fetal Diseases - diagnostic imaging ; Fetal Diseases - pathology ; fetal hemodynamics ; Fetal Hypoxia - physiopathology ; Head - physiopathology ; Humans ; hypoplastic left heart syndrome ; Hypoplastic Left Heart Syndrome - diagnostic imaging ; Hypoplastic Left Heart Syndrome - pathology ; Infant, Newborn ; Middle Cerebral Artery - diagnostic imaging ; Middle Cerebral Artery - physiopathology ; middle cerebral artery flow ; Placental Circulation - physiology ; Pregnancy ; Pulsatile Flow - physiology ; Retrospective Studies ; Transposition of Great Vessels - diagnostic imaging ; Transposition of Great Vessels - pathology</subject><ispartof>Ultrasound in obstetrics & gynecology, 2013-09, Vol.42 (3), p.294-299</ispartof><rights>Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4218-92e0c6c6476fa2b88bc015bd3e4afe8863a08e15edd3dbf5eedaff9cc089edb03</citedby><cites>FETCH-LOGICAL-c4218-92e0c6c6476fa2b88bc015bd3e4afe8863a08e15edd3dbf5eedaff9cc089edb03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.12448$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.12448$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23456797$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yamamoto, Y.</creatorcontrib><creatorcontrib>Khoo, N. S.</creatorcontrib><creatorcontrib>Brooks, P. A.</creatorcontrib><creatorcontrib>Savard, W.</creatorcontrib><creatorcontrib>Hirose, A.</creatorcontrib><creatorcontrib>Hornberger, L. K.</creatorcontrib><title>Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objective
Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA‐PI and head growth.
Methods
We retrospectively reviewed fetal echocardiograms of pregnancies complicated by fetal hypoplastic left heart syndrome (HLHS; n = 42) with and without anatomic coarctation (n = 28 and n = 10, respectively), isolated severe aortic coarctation (n = 21), D‐transposition of the great arteries (TGA; n = 11) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (POTO; n = 15), comparing observations with gestational age‐matched controls (n = 89). No fetus had major extracardiac pathology or aneuploidy. MCA and umbilical artery (UA) PI, the cerebral placental ratio (CPR = MCA‐PI/ UA‐PI) and neonatal head circumference were obtained and expressed as Z‐scores.
Results
Lower MCA‐PI, higher UA‐PI and lower CPR were observed in fetal HLHS and isolated coarctation with reversed arch flow (n = 6) (P < 0.001) but not TGA, POTO or isolated coarctation with antegrade arch flow (n = 15) compared with controls. No difference was found between HLHS with anatomical coarctation and those without; however, MCA‐PI correlated positively with neonatal head circumference in HLHS with reversed distal arch flow (r = 0.33, P < 0.05).
Conclusions
Severe left heart obstruction with reversed aortic arch flow is associated with altered fetal cerebral blood flow, and in these conditions, MCA‐PI positively correlates with head growth. Anatomical arch obstruction itself may not be a contributing factor to altered MCA flow in fetal HLHS. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2013:42:255–256</description><subject>Aneuploidy</subject><subject>Aorta, Thoracic - pathology</subject><subject>Aortic Coarctation - diagnostic imaging</subject><subject>Aortic Coarctation - pathology</subject><subject>brain sparing</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>coarctation</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Fetal Development - physiology</subject><subject>Fetal Diseases - diagnostic imaging</subject><subject>Fetal Diseases - pathology</subject><subject>fetal hemodynamics</subject><subject>Fetal Hypoxia - physiopathology</subject><subject>Head - physiopathology</subject><subject>Humans</subject><subject>hypoplastic left heart syndrome</subject><subject>Hypoplastic Left Heart Syndrome - diagnostic imaging</subject><subject>Hypoplastic Left Heart Syndrome - pathology</subject><subject>Infant, Newborn</subject><subject>Middle Cerebral Artery - diagnostic imaging</subject><subject>Middle Cerebral Artery - physiopathology</subject><subject>middle cerebral artery flow</subject><subject>Placental Circulation - physiology</subject><subject>Pregnancy</subject><subject>Pulsatile Flow - physiology</subject><subject>Retrospective Studies</subject><subject>Transposition of Great Vessels - diagnostic imaging</subject><subject>Transposition of Great Vessels - pathology</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc9rFDEUgIModq0e_Ack4EUP0778mCRzlKJVKPSgPQ_58dKdJTtZk5ku_e-d3a0eBMFTHuF7Hzw-Qt4yuGAA_HLO9xeMS2mekRWTqmtAQ_ucrKBT0GjV8TPyqtYNACgp1EtyxoVsle70imy-4wMWpAnjRNdoy0Szq1OZ_TTkke6HaU0LTiXfFxuQ2uLXNKa8p8MY04yjx0ojTjZRv2hcWQY7BrpL1uN4-HYp53BceU1eRJsqvnl6z8ndl88_rr42N7fX364-3TRecmaajiN45ZXUKlrujHEeWOuCQGkjGqOEBYOsxRBEcLFFDDbGznswHQYH4px8OHl3Jf-csU79dqgeU7Ij5rn2TAoJXAnN_wPlnZG67Q7W93-hmzyXcTnkSHGtQaiF-niifMm1Foz9rgxbWx57Bv2hVb-06o-tFvbdk3F2Wwx_yN9xFuDyBOyHhI__NvV3t9cn5S-3Bp9w</recordid><startdate>201309</startdate><enddate>201309</enddate><creator>Yamamoto, Y.</creator><creator>Khoo, N. S.</creator><creator>Brooks, P. A.</creator><creator>Savard, W.</creator><creator>Hirose, A.</creator><creator>Hornberger, L. K.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>201309</creationdate><title>Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow</title><author>Yamamoto, Y. ; Khoo, N. S. ; Brooks, P. A. ; Savard, W. ; Hirose, A. ; Hornberger, L. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4218-92e0c6c6476fa2b88bc015bd3e4afe8863a08e15edd3dbf5eedaff9cc089edb03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aneuploidy</topic><topic>Aorta, Thoracic - pathology</topic><topic>Aortic Coarctation - diagnostic imaging</topic><topic>Aortic Coarctation - pathology</topic><topic>brain sparing</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>coarctation</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Fetal Development - physiology</topic><topic>Fetal Diseases - diagnostic imaging</topic><topic>Fetal Diseases - pathology</topic><topic>fetal hemodynamics</topic><topic>Fetal Hypoxia - physiopathology</topic><topic>Head - physiopathology</topic><topic>Humans</topic><topic>hypoplastic left heart syndrome</topic><topic>Hypoplastic Left Heart Syndrome - diagnostic imaging</topic><topic>Hypoplastic Left Heart Syndrome - pathology</topic><topic>Infant, Newborn</topic><topic>Middle Cerebral Artery - diagnostic imaging</topic><topic>Middle Cerebral Artery - physiopathology</topic><topic>middle cerebral artery flow</topic><topic>Placental Circulation - physiology</topic><topic>Pregnancy</topic><topic>Pulsatile Flow - physiology</topic><topic>Retrospective Studies</topic><topic>Transposition of Great Vessels - diagnostic imaging</topic><topic>Transposition of Great Vessels - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yamamoto, Y.</creatorcontrib><creatorcontrib>Khoo, N. S.</creatorcontrib><creatorcontrib>Brooks, P. A.</creatorcontrib><creatorcontrib>Savard, W.</creatorcontrib><creatorcontrib>Hirose, A.</creatorcontrib><creatorcontrib>Hornberger, L. K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yamamoto, Y.</au><au>Khoo, N. S.</au><au>Brooks, P. A.</au><au>Savard, W.</au><au>Hirose, A.</au><au>Hornberger, L. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2013-09</date><risdate>2013</risdate><volume>42</volume><issue>3</issue><spage>294</spage><epage>299</epage><pages>294-299</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><coden>UOGYFJ</coden><abstract>ABSTRACT
Objective
Decreased middle cerebral artery (MCA) pulsatility index (PI) is a marker of fetal brain‐sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on MCA‐PI and head growth.
Methods
We retrospectively reviewed fetal echocardiograms of pregnancies complicated by fetal hypoplastic left heart syndrome (HLHS; n = 42) with and without anatomic coarctation (n = 28 and n = 10, respectively), isolated severe aortic coarctation (n = 21), D‐transposition of the great arteries (TGA; n = 11) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (POTO; n = 15), comparing observations with gestational age‐matched controls (n = 89). No fetus had major extracardiac pathology or aneuploidy. MCA and umbilical artery (UA) PI, the cerebral placental ratio (CPR = MCA‐PI/ UA‐PI) and neonatal head circumference were obtained and expressed as Z‐scores.
Results
Lower MCA‐PI, higher UA‐PI and lower CPR were observed in fetal HLHS and isolated coarctation with reversed arch flow (n = 6) (P < 0.001) but not TGA, POTO or isolated coarctation with antegrade arch flow (n = 15) compared with controls. No difference was found between HLHS with anatomical coarctation and those without; however, MCA‐PI correlated positively with neonatal head circumference in HLHS with reversed distal arch flow (r = 0.33, P < 0.05).
Conclusions
Severe left heart obstruction with reversed aortic arch flow is associated with altered fetal cerebral blood flow, and in these conditions, MCA‐PI positively correlates with head growth. Anatomical arch obstruction itself may not be a contributing factor to altered MCA flow in fetal HLHS. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2013:42:255–256</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>23456797</pmid><doi>10.1002/uog.12448</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Free Content; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals |
| subjects | Aneuploidy Aorta, Thoracic - pathology Aortic Coarctation - diagnostic imaging Aortic Coarctation - pathology brain sparing Cerebrovascular Circulation - physiology coarctation Echocardiography Female Fetal Development - physiology Fetal Diseases - diagnostic imaging Fetal Diseases - pathology fetal hemodynamics Fetal Hypoxia - physiopathology Head - physiopathology Humans hypoplastic left heart syndrome Hypoplastic Left Heart Syndrome - diagnostic imaging Hypoplastic Left Heart Syndrome - pathology Infant, Newborn Middle Cerebral Artery - diagnostic imaging Middle Cerebral Artery - physiopathology middle cerebral artery flow Placental Circulation - physiology Pregnancy Pulsatile Flow - physiology Retrospective Studies Transposition of Great Vessels - diagnostic imaging Transposition of Great Vessels - pathology |
| title | Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow |
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