Format

Send to

Choose Destination
Circulation. 2015 Apr 14;131(15):1313-23. doi: 10.1161/CIRCULATIONAHA.114.013051. Epub 2015 Mar 11.

Reduced fetal cerebral oxygen consumption is associated with smaller brain size in fetuses with congenital heart disease.

Author information

1
From Department of Ultrasound, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (L.S.); Division of Pediatric Cardiology, Department of Pediatrics (L.S., S.-J.Y., C.M., P.P., L.G.-W., E.J., B.W.M., M.S.), Department of Physiology and Experimental Medicine (C.K.M., J.G.S.), Department of Diagnostic Imaging (S.-J.Y., L.G.-W., M.S.), Department of Cardiovascular Surgery (E.H.), and Department of Pediatric Neurology (S.M.), University of Toronto and Hospital for Sick Children, Toronto, ON, Canada; and Department of Obstetrics and Gynecology, University of Toronto and Mount Sinai Hospital, Toronto, ON, Canada (J.K.).
2
From Department of Ultrasound, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (L.S.); Division of Pediatric Cardiology, Department of Pediatrics (L.S., S.-J.Y., C.M., P.P., L.G.-W., E.J., B.W.M., M.S.), Department of Physiology and Experimental Medicine (C.K.M., J.G.S.), Department of Diagnostic Imaging (S.-J.Y., L.G.-W., M.S.), Department of Cardiovascular Surgery (E.H.), and Department of Pediatric Neurology (S.M.), University of Toronto and Hospital for Sick Children, Toronto, ON, Canada; and Department of Obstetrics and Gynecology, University of Toronto and Mount Sinai Hospital, Toronto, ON, Canada (J.K.). mike.seed@sickkids.ca.

Abstract

BACKGROUND:

Fetal hypoxia has been implicated in the abnormal brain development seen in newborns with congenital heart disease (CHD). New magnetic resonance imaging technology now offers the potential to investigate the relationship between fetal hemodynamics and brain dysmaturation.

METHODS AND RESULTS:

We measured fetal brain size, oxygen saturation, and blood flow in the major vessels of the fetal circulation in 30 late-gestation fetuses with CHD and 30 normal controls using phase-contrast magnetic resonance imaging and T2 mapping. Fetal hemodynamic parameters were calculated from a combination of magnetic resonance imaging flow and oximetry data and fetal hemoglobin concentrations estimated from population averages. In fetuses with CHD, reductions in umbilical vein oxygen content (P<0.001) and failure of the normal streaming of oxygenated blood from the placenta to the ascending aorta were associated with a mean reduction in ascending aortic saturation of 10% (P<0.001), whereas cerebral blood flow and cerebral oxygen extraction were no different from those in controls. This accounted for the mean 15% reduction in cerebral oxygen delivery (P=0.08) and 32% reduction cerebral Vo2 in CHD fetuses (P<0.001), which were associated with a 13% reduction in fetal brain volume (P<0.001). Fetal brain size correlated with ascending aortic oxygen saturation and cerebral Vo2 (r=0.37, P=0.004).

CONCLUSIONS:

This study supports a direct link between reduced cerebral oxygenation and impaired brain growth in fetuses with CHD and raises the possibility that in utero brain development could be improved with maternal oxygen therapy.

KEYWORDS:

brain; heart diseases; hemodynamics; magnetic resonance imaging; pediatrics

PMID:
25762062
PMCID:
PMC4398654
DOI:
10.1161/CIRCULATIONAHA.114.013051
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center