The Fetal Heart Program at Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Ultrasound Obstet Gynecol. 2012 Jul;40(1):62-7. doi: 10.1002/uog.11147. Epub 2012 Jun 8.
We sought to determine whether the presence or absence of aortic obstruction impacts cerebrovascular resistance in fetuses with single-ventricle (SV) congenital heart disease (CHD).
Pulsatility indices (PIs) were recorded for the middle cerebral artery (MCA) and the umbilical artery (UA) from 18 to 40 weeks' gestation in 59 fetuses (163 examinations) with SV-CHD with unobstructed aortic flow, yet decreased pulmonary flow, in 72 fetuses (170 examinations) with obstructed aortic flow and hypoplastic left heart syndrome (HLHS) and in 92 normal fetuses (92 examinations). The cerebral-to-placental resistance (CPR) was calculated as the MCA-PI/UA-PI. Z-scores were generated for the MCA-PI and the UA-PI in order to make comparisons independent of gestational age. Statistical analyses were performed using one-way ANOVA with post-hoc testing. Trends in these variables over the course of gestation were assessed using linear regression and univariate ANOVA.
The MCA-PI and the CPR were significantly lower in SV fetuses with aortic obstruction compared with SV fetuses with pulmonary obstruction and with normal fetuses. Moreover, the MCA-PI decreased significantly for SV fetuses with aortic obstruction over the course of gestation. In contrast, the MCA-PI was higher over the course of gestation in SV fetuses with pulmonary obstruction compared with normal fetuses.
In fetuses with SV-CHD, cerebrovascular resistance varies substantially between fetuses with and without aortic obstruction. Compared with normal fetuses, cerebrovascular resistance is decreased in SV fetuses with aortic obstruction, yet increased in SV fetuses with pulmonary obstruction. In fetuses with SV physiology, inherent differences in cerebral blood flow may underlie postnatal neurodevelopmental outcomes.
我们旨在确定主动脉阻塞的存在与否是否会影响患有单心室（SV）先天性心脏病（CHD）的胎儿的脑血管阻力。
从 18 周到 40 周的妊娠期间，对 59 例 SV-CHD 胎儿（163 次检查）记录大脑中动脉（MCA）和脐动脉（UA）的搏动指数（PI）。其中 72 例胎儿（170 次检查）有主动脉阻塞和左心发育不良综合征（HLHS），92 例正常胎儿（92 次检查）主动脉血流通畅。脑胎盘阻力（CPR）被计算为 MCA-PI/UA-PI。MCA-PI 和 UA-PI 的 Z 分数用于生成，以便使比较独立于胎龄。使用单因素方差分析进行统计分析，并进行事后检验。使用线性回归和单因素方差分析评估这些变量在妊娠过程中的趋势。
与 SV 肺动脉阻塞胎儿和正常胎儿相比，SV 主动脉阻塞胎儿的 MCA-PI 和 CPR 明显较低。此外，SV 主动脉阻塞胎儿的 MCA-PI 在妊娠过程中显著降低。相比之下，SV 肺动脉阻塞胎儿的 MCA-PI 在妊娠过程中高于正常胎儿。
在患有 SV-CHD 的胎儿中，有主动脉阻塞和无主动脉阻塞的胎儿之间脑血管阻力存在显著差异。与正常胎儿相比，SV 主动脉阻塞胎儿的脑血管阻力降低，而 SV 肺动脉阻塞胎儿的脑血管阻力升高。在 SV 生理胎儿中，脑血流的固有差异可能是导致出生后神经发育结果不同的原因。
