Autoregulation of cerebral blood flow in fetuses with congenital heart disease: The brain sparing effect

被引:277
作者
Donofrio, MT
Bremer, YA
Schieken, RM
Gennings, C
Morton, LD
Eidem, BW
Cetta, F
Falkensammer, CB
Huhta, JC
Kleinman, CS
机构
[1] Virginia Commonwealth Univ, Med Coll Virginia Hosp, Richmond, VA 23298 USA
[2] Loyola Univ, Med Ctr, Maywood, IL 60153 USA
[3] Tampa Childrens Hosp, Tampa, FL 33607 USA
[4] Columbia Univ, Babies & Childrens Hosp, New York, NY 10032 USA
关键词
congenital heart defects; fetal circulation; cerebrovascular circulation; fetal echocardiography;
D O I
10.1007/s00246-002-0404-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Fetuses with congenital heart disease (CHD) have circulatory abnormalities that may compromise cerebral oxygen delivery. We believe that some CHD fetuses with decreased cerebral oxygen supply have autoregulation of blood flow that enhances cerebral perfusion (brain sparing). We hypothesize that cerebral autoregulation occurs in CHD fetuses, and the degree of autoregulation is dependent on the specific CHD and correlates with intrauterine head circumferences. CHD fetuses were compared to normal fetuses. Data included cardiac diagnosis, cerebral and umbilical artery Doppler, head circumference, weight, and gestational age. The cerebral-to-placental resistance ratio (CPR) was assessed as a measure of cerebral autoregulation. CPR = cerebral/umbilical resistance index (RI) and RI = systolic diastolic/systolic velocity (normal CPR > 1). CPR > 1 was found in 95% of normal vs 44% of CHD fetuses. The incidence of CPR < 1 was greatest in hypoplastic left or right heart fetuses. Compared to normal, cerebral RI was decreased in CHD fetuses. The CPR vs gestational age relationship, and the relationship among weight, head circumference, and CPR differed across normal and CHD fetuses. Fetuses > 2 kg with CHD and a CPR < 1 had smaller head circumferences than normal. Brain sparing occurs in CHD fetuses. Fetuses with single ventricular physiology are most affected. Inadequate cerebral flow in CHD fetuses, despite autoregulation, may alter brain growth.
引用
收藏
页码:436 / 443
页数:8
相关论文
共 20 条
[1]  
ARBEILLE PH, 1997, ULTRASOUND MED BIOL, V13, P329
[2]   Reversed shunting across the ductus arteriosus or atrial septum in utero heralds severe congenital heart disease [J].
Berning, RA ;
Silverman, NH ;
Villegas, M ;
Sahn, DJ ;
Martin, GR ;
Rice, MJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 27 (02) :481-486
[3]   GYRAL DEVELOPMENT OF HUMAN-BRAIN [J].
CHI, JG ;
DOOLING, EC ;
GILLES, FH .
ANNALS OF NEUROLOGY, 1977, 1 (01) :86-93
[4]   Correlation between prenatal velocity waveforms in the aortic isthmus and neurodevelopmental outcome between the ages of 2 and 4 years [J].
Fouron, JC ;
Gosselin, J ;
Amiel-Tison, C ;
Infante-Rivard, C ;
Fouron, C ;
Skoll, A ;
Veilleux, A .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2001, 184 (04) :630-636
[5]   CONTROL OF FETAL CARDIAC-OUTPUT DURING CHANGES IN BLOOD-VOLUME [J].
GILBERT, RD .
AMERICAN JOURNAL OF PHYSIOLOGY, 1980, 238 (01) :H80-H86
[6]  
GLAUSER TA, 1990, PEDIATRICS, V85, P984
[7]  
GLAUSER TA, 1990, PEDIATRICS, V85, P991
[8]   CEREBRAL-UMBILICAL DOPPLER RATIO AS A PREDICTOR OF ADVERSE PERINATAL OUTCOME [J].
GRAMELLINI, D ;
FOLLI, MC ;
RABONI, S ;
VADORA, E ;
MERIALDI, A .
OBSTETRICS AND GYNECOLOGY, 1992, 79 (03) :416-420
[9]  
HEYMANN M A, 1972, Progress in Cardiovascular Diseases, V15, P115, DOI 10.1016/0033-0620(72)90015-1
[10]   Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery [J].
Limperopoulos, C ;
Majnemer, A ;
Shevell, MI ;
Rosenblatt, B ;
Roblicek, C ;
Tchervenkov, C .
JOURNAL OF PEDIATRICS, 2000, 137 (05) :638-645