Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands.
Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
Prenat Diagn. 2021 Jan;41(1):43-51. doi: 10.1002/pd.5813. Epub 2020 Sep 7.
Presumably, changes in fetal circulation contribute to the delay in maturation of the cortex in fetuses with congenital heart defect (CHD). The aim of the current study is to analyze fetal brain development based on hemodynamic differences, using novel brain-age prediction software.
We have performed detailed neurosonography, including acquiring 3D volumes, prospectively in cases with isolated CHD from 20 weeks onwards. An algorithm that assesses the degree of fetal brain-age automatically was used to compare CHD cases to controls. We stratified CHD cases according to flow and oxygenation profiles by lesion physiology and performed subgroup analyses.
A total of 616 ultrasound volumes of 162 CHD cases and 75 controls were analyzed. Significant differences in maturation of the cortex were observed in cases with normal blood flow toward the brain (-3.8 days, 95%CI [-5.5; -2.0], P = <.001) and low (-4.0 days, 95% CI [-6.7; -1.2] P = <.05; hypoplastic left heart syndrome[HLHS]) and mixed (-4.4 days, 95%CI [-6.4; -2.5] p = <.001) oxygen saturation in the ascending aorta (TGA) and in cardiac mixing (eg, Fallot) cases.
The current study shows significant delay in brain-age in TGA and Fallot cases as compared to control cases. However, the small differences found in this study questions the clinical relevance.
据推测，胎儿循环的变化导致伴有先天性心脏病（CHD）的胎儿皮质成熟延迟。本研究的目的是使用新型脑龄预测软件，根据血流动力学差异分析胎儿脑发育。
我们对 20 周后患有孤立性 CHD 的病例进行了详细的神经超声检查，包括获取 3D 容积。使用一种自动评估胎儿脑龄程度的算法，将 CHD 病例与对照组进行比较。我们根据病变生理学对 CHD 病例进行了血流和氧合分布分层，并进行了亚组分析。
共分析了 162 例 CHD 病例和 75 例对照的 616 个超声容积。在血流正常的情况下，皮质成熟存在显著差异（-3.8 天，95%CI [-5.5；-2.0]，P<0.001），而在脑血流减少的情况下（-4.0 天，95%CI [-6.7；-1.2]，P=0.05；左心发育不良综合征[HLHS]）和混合（-4.4 天，95%CI [-6.4；-2.5]，P<0.001）主动脉上升段（TGA）和心脏混合（如法洛四联症）的情况下，氧饱和度降低。
与对照组相比，TGA 和法洛四联症病例的脑龄明显延迟。然而，本研究中发现的微小差异质疑了其临床相关性。
