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

M. T. Donofrio, Y. A. Bremer, R. M. Schieken, C. Gennings, L. D. Morton, B. W. Eidem, F. Cetta, C. B. Falkensammer, J. C. Huhta, C. S. Kleinman

Research output: Contribution to journalArticle

220 Scopus citations

Abstract

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-toplacental 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.

Original languageEnglish (US)
Pages (from-to)436-443
Number of pages8
JournalPediatric Cardiology
Volume24
Issue number5
DOIs
StatePublished - Sep 2003
Externally publishedYes

Keywords

  • Cerebrovascular circulation
  • Congenital heart defects
  • Fetal circulation
  • Fetal echocardiography

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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