Fetal cerebrovascular impedance is reduced in left congenital diaphragmatic hernia

Autor: Vickie A. Feldstein, Anita J. Moon-Grady, K A Kosiv, Elizabeth E. Rogers, R Rapoport, Hanmin Lee, Whitnee Hogan, Roberta L. Keller, Shabnam Peyvandi
Rok vydání: 2021
Předmět:
Middle Cerebral Artery
Cardiac output
Reproductive health and childbirth
Cardiovascular
Umbilical Arteries
Functional Laterality
congenital diaphragmatic hernia
Fetal Development
Congenital
0302 clinical medicine
Pregnancy
Infant Mortality
Electric Impedance
Prenatal
030212 general & internal medicine
middle cerebral artery pulsatility index
Ultrasonography
Hernias
Pediatric
education.field_of_study
030219 obstetrics & reproductive medicine
neurodevelopment
Radiological and Ultrasound Technology
Impedance
Obstetrics and Gynecology
Gestational age
General Medicine
Stroke volume
Cerebral blood flow
Echocardiography
Cerebrovascular Circulation
Pulsatile Flow
Middle cerebral artery
Cardiology
Biomedical Imaging
Female
cerebrovascular resistance
medicine.medical_specialty
cerebral sparing
Cardiography
Physiological
Population
Gestational Age
Paediatrics and Reproductive Medicine
03 medical and health sciences
Fetus
Clinical Research
Internal medicine
medicine.artery
medicine
Humans
Radiology
Nuclear Medicine and imaging
Adaptation
Obstetrics & Reproductive Medicine
education
business.industry
Neurosciences
Congenital diaphragmatic hernia
Umbilical artery
Perinatal Period - Conditions Originating in Perinatal Period
medicine.disease
Brain Disorders
Reproductive Medicine
Neurodevelopmental Disorders
Case-Control Studies
Digestive Diseases
business
Diaphragmatic
Zdroj: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol 57, iss 3
ISSN: 1469-0705
0960-7692
DOI: 10.1002/uog.21992
Popis: OBJECTIVES Congenital diaphragmatic hernia (CDH) can cause a significant mass effect in the fetal thorax, displacing the heart into the opposite hemithorax. In left-sided CDH (L-CDH), this is associated with smaller left-sided cardiac structures and reduced left-ventricular cardiac output (LVCO). The effect of these physiologic changes on cerebral blood flow is not well understood. We sought to describe the middle cerebral artery (MCA) pulsatility index (PI), a measure of cerebrovascular impedance, in fetuses with L-CDH and those with right-sided CDH (R-CDH) compared with unaffected fetuses, and the relationship between MCA-PI and LVCO. We hypothesized that MCA-PI would be lower in fetuses with L-CDH and similar in those with R-CDH compared to controls, and that MCA-PI would be correlated with LVCO. METHODS We identified all fetuses with CDH evaluated at The University of California San Francisco, San Francisco, CA, USA from 2011 to 2018. Fetal echocardiograms and ultrasound scans were reviewed. Umbilical artery and MCA Doppler examinations were assessed to calculate pulsatility indices. Ventricular outputs were calculated using Doppler-derived stroke volume and fetal heart rate. Lung-to-head ratio (LHR), estimated fetal weight, biparietal diameter (BPD) and head circumference (HC) were obtained from fetal sonograms. Measurements in fetuses with CDH, according to the side of the defect, were compared with those in unaffected, gestational age-matched controls. A subset of CDH survivors had available data on neurodevelopmental outcome, as assessed using the Bayley Scales of Infant Development, 3rd edition. RESULTS A total of 64 fetuses with CDH (L-CDH, n = 53; R-CDH, n = 11) comprised the study groups, with 27 unaffected fetuses serving as controls. Mean gestational age at evaluation was similar between the three groups. Compared to controls, fetuses with L-CDH had significantly lower LVCO expressed as a percentage of combined cardiac output (CCO) (32%; 95% CI, 29-35% vs 38%; 95% CI, 33-42%; P = 0.04) and lower MCA-PI Z-score (-1.3; 95% CI, -1.7 to -1.0 vs 0.08; 95% CI, -0.5 to 0.6; P
Databáze: OpenAIRE
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