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OC25.01: Cerebral oxygen delivery, brain growth and white matter maturation are reduced in congenital heart disease fetuses

2016; Wiley; Volume: 48; Issue: S1 Linguagem: Inglês

10.1002/uog.16145

1469-0705

Joyce Lim, Prakash Muthusami, Sujana Madathil, Meng Yuan Zhu, Brahmdeep S. Saini, Prashob Porayette, Vann Chau, Sharon Portnoy, Christopher K. Macgowan, John G. Sled, John‏ Kingdom, Mike Seed, Steven P. Miller,

Pregnancy and preeclampsia studies

To investigate the relationship between fetal hemodynamics and brain growth and maturation in congenital heart disease (CHD) fetuses using magnetic resonance imaging (MRI). Fetal and newborn brain MRI was performed at 37 ± 1 and 40 ± 1.5 weeks respectively on a 1.5 T scanner. Fetal hemodynamics were assessed using our previously published technique, consisting of blood flow measures and T2 based oximetry. We measured fetal combined ventricular output (CVO), umbilical vein (UV) flow, oxygen content (estimated hematocrit), oxygen delivery (DO2) and consumption (VO2). Using superior vena cava flow (QSVC) for cerebral blood flow, we measured cerebral DO2, VO2 (CDO2 & CVO2) and oxygen extraction fraction (OEF) using QSVC and the oxygen saturation (SaO2) difference in the ascending aorta and SVC. All brain volumes (BV) were calculated by segmenting a 3D brain acquisition. Newborn white matter microstructure (WMM) was examined using a diffusion tensor imaging (DTI) sequence with 12 manually placed regions of interest. 46 normal and 40 CHD fetuses were scanned, of which 35 normal and 34 CHD had newborn DTI. Gestational age and body weight was not different between groups. CHD fetal CDO2 was significantly lower due to lower QUV, UVSaO2, and poor streaming. Despite a larger fraction of DO2 directed to the fetal brain, this was associated with smaller newborn BV. CDO2 and CVO2 indexed to BV were not different between groups. However, when indexed to fetal weight, we found significant correlations between CDO2 and CVO2 and neonatal BV (both p = 0.04, r2 = 0.05). The lack of brain growth shown in CHD newborns was associated with abnormal WMM on DTI, but DTI was not significantly correlated with any fetal hemodynamic parameters. Our results are in keeping with a hemodynamic driver of impaired fetal brain growth typical of CHD.