Fetal & Neonatal Cardiology Program, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2021 Mar;37(3):425-432. doi: 10.1016/j.cjca.2020.06.024. Epub 2020 Jul 10.
Children with congenital heart disease (CHD) are at risk of adverse long-term neurodevelopmental outcomes, believed to be, in part, secondary to prenatal insults. Placental pathology and altered fetal middle cerebral arterial (MCA) flow suggestive of brain sparing have been documented in fetal CHD. In the present study we investigated the relationship between MCA and umbilical arterial (UA) flow patterns in fetal transposition of the great arteries (d-TGA) and hypoplastic left heart syndrome (HLHS) and growth and 2-year neurodevelopmental outcomes.
We included children with d-TGA and HLHS who had third-trimester fetal echocardiograms between 2004 and 2014, at which time umbilical artery (UA) and MCA pulsatility indices (PIs) were measured, and who underwent 2-year growth and neurodevelopmental assessments.
We identified 24 children with d-TGA and 36 with HLHS. Mean age at fetal echocardiography was 33.8 ± 3.5 weeks. At 2-year follow-up, head circumference z score (standard deviation [SD]) was -0.09 (1.07) and 0.17 (1.7) for the d-TGA and HLHS groups, respectively. Bayley III mean (SD) cognitive, language, and motor scores were 97.7 (10.8), 94.7 (13.4), and 98.6 (8.6) for the d-TGA group and 90.3 (13.9), 87.2 (17.5), and 85.3 (16.2) for the HLHS group. On multivariate linear regression analysis, UA-PI was associated (effect sizes [95% CI]) with length (-1.45 [-2.7, -0.17], P = 0.027), weight (-1.46 [-2.6 to -0.30], P = 0.015) and cognitive scores (-14.86 [-29.95 to 0.23], P = 0.05) at 2 years of age. MCA PI showed no statistically significant correlation.
In fetal d-TGA and HLHS, a higher UA-PI in the third trimester, suggestive of placental insufficiency-but not MCA-PI-is associated with worse 2-year growth and neurodevelopment.
患有先天性心脏病（CHD）的儿童存在不良长期神经发育结局的风险，部分原因被认为是产前损伤。已有研究表明，在胎儿 CHD 中存在胎盘病理学和胎儿大脑中动脉（MCA）血流改变，提示存在脑保护。在本研究中，我们调查了胎儿大动脉转位（d-TGA）和左心发育不全综合征（HLHS）中 MCA 和脐动脉（UA）血流模式之间的关系，以及它们与生长和 2 年神经发育结局的关系。
我们纳入了 2004 年至 2014 年间在妊娠晚期进行胎儿超声心动图检查的 d-TGA 和 HLHS 患儿，检查时测量了脐动脉（UA）和 MCA 搏动指数（PI），并进行了 2 年的生长和神经发育评估。
我们共纳入 24 例 d-TGA 患儿和 36 例 HLHS 患儿。胎儿超声心动图检查时的平均年龄为 33.8±3.5 周。2 年随访时，d-TGA 和 HLHS 组头围 z 评分（标准差）分别为-0.09（1.07）和 0.17（1.7）。d-TGA 组的贝利 III 平均（标准差）认知、语言和运动评分分别为 97.7（10.8）、94.7（13.4）和 98.6（8.6），HLHS 组分别为 90.3（13.9）、87.2（17.5）和 85.3（16.2）。多变量线性回归分析显示，UA-PI 与 2 岁时的身长（-1.45[-2.7，-0.17]，P=0.027）、体重（-1.46[-2.6 至-0.30]，P=0.015）和认知评分（-14.86[-29.95 至 0.23]，P=0.05）相关。MCA-PI 无统计学显著相关性。
在胎儿 d-TGA 和 HLHS 中，妊娠晚期 UA-PI 升高提示胎盘功能不全，但 MCA-PI 升高与 2 岁时的生长和神经发育不良无关。
