Leiden University Medical Centre, Department of Obstetrics and Fetal Medicine, Leiden, The Netherlands,
Leiden University Medical Centre, Department of Medical Statistics, Leiden, The Netherlands.
Fetal Diagn Ther. 2019;45(4):212-220. doi: 10.1159/000488674. Epub 2019 Jan 17.
The aim of our study is to explore whether the cerebral growth is delayed in fetuses with congenital heart defects (CHD) in the second and early third trimester.
A prospective cohort study was conducted in 77 CHD cases, with 75 healthy controls. 3D cerebral volume acquisition was performed sequentially. The volumes of the fetal hemicerebrum and extracerebral fluid were compared by linear regression analysis, and the Sylvian fissure was measured.
Between 19 and 32 weeks of gestation, 158 measurements in cases and 183 measurements in controls were performed (mean 2.2/subject). The volume growth of the hemicerebrum (R2 = 0.95 vs. 0.95; p = 0.9) and the extracerebral fluid (R2 = 0.84 vs. 0.82, p = 0.9) were similar. Fetuses with abnormal oxygen delivery to the brain have a slightly smaller brain at 20 weeks of gestation (p = 0.02), but this difference disappeared with advancing gestation. CHD cases demonstrated a slightly shallower Sylvian fissure (mean ratio 0.146 vs. 0.153; p = 0.004).
Our study shows no differences in cerebral growth, studied in an unselected cohort, with successive cases of isolated CHD. Even in the severest CHD cases, cerebral size is similar in the early third trimester. The cause and meaning of a shallower Sylvian fissure is unclear; possibly, it is a marker for delayed cerebral maturation or it might be an expression of decreasing amount of extracerebral fluid.
我们的研究旨在探讨在孕中期和孕早期，先天性心脏病（CHD）胎儿的大脑生长是否延迟。
对 77 例 CHD 病例和 75 例健康对照进行前瞻性队列研究。对胎儿大脑进行三维容积采集。采用线性回归分析比较胎儿大脑半球和脑外间隙的体积，并测量侧裂池的深度。
在 19 周至 32 周的妊娠期间，对 158 例病例和 183 例对照进行了测量（平均每例 2.2 次）。大脑半球（R2=0.95 对 0.95；p=0.9）和脑外间隙（R2=0.84 对 0.82；p=0.9）的体积增长相似。向大脑供氧异常的胎儿在 20 周时大脑略小（p=0.02），但随着妊娠的进展，这种差异消失。CHD 病例的侧裂池稍浅（平均比值 0.146 对 0.153；p=0.004）。
我们的研究表明，在一个未选择的队列中，孤立性 CHD 的连续病例之间，大脑生长没有差异。即使在最严重的 CHD 病例中，大脑在孕晚期的大小也相似。侧裂池较浅的原因和意义尚不清楚；可能是脑成熟延迟的标志物，也可能是脑外间隙减少的表现。
