Head Biometry in Fetuses with Isolated Congenital Heart Disease

Abstract

Purpose Altered cerebral hemodynamics are involved in changes in head biometry in fetuses with congenital heart disease (CHD). We compared head growth in different CHD groups with published normative values and investigated whether CHD groups differ from each other in terms of head circumference (HC) development over gestational age (GA).

Materials and Methods Retrospective cohort study consisting of 248 CHD fetuses. Subgroups were generated according to the expected ascending aorta oxygen saturation: Low placental blood content (BC) and therefore low oxygen delivery to the brain (group 1: n = 108), intermediate placental and systemic BC due to intracardiac mixing of blood (group 2: n = 103), high placental BC (group 3: n = 13) and low placental BC and low oxygen delivery to the brain without mixing of blood (group 4: n = 24). Furthermore, group 1 was divided into antegrade (n = 34) and retrograde (n = 74) flow through the aortic arch. Comparisons were made at a GA of 22, 30 and 38 weeks.

Results Estimated values of zHC (z-score transformed) were not significantly different between the four CHD groups at the three time points in gestation (all p > 0.05). Within group 1 fetuses with retrograde aortic arch flow showed a significant negative association between HC and GA compared to reference values (b = –0.054, p < 0.001) and had significantly lower zHC values at 38 weeks (–0.836) compared to fetuses with antegrade flow (0.366, p = 0.009).

Conclusion Our data do not confirm that CHD fetuses in general have a significantly smaller HC. HC becomes smaller throughout gestation depending on the direction of aortic arch flow.

Zusammenfassung

Ziel Änderungen der zerebralen Hämodynamik sind von Bedeutung für die Kopfbiometrie bei Feten mit angeborenem Herzfehler (CHD). Ziel der Studie war es, das Kopfwachstum in verschiedenen CHD-Gruppen mit publizierten Normwerten zu vergleichen und zu untersuchen, ob sich die CHD-Gruppen hinsichtlich der Kopfumfang (KU) -Entwicklung über das Gestationsalter (GA) voneinander unterscheiden.

Material und Methode Es handelt sich um eine retrospektive Kohorten-Studie, bestehend aus 248 CHD-Feten. Die CHD-Untergruppen wurden entsprechend der erwarteten Sauerstoffsättigung in der aszendierenden Aorta gebildet: Niedriges plazentares Blutvolumen (BV) und daher geringe Sauerstoffzufuhr zum Gehirn (Gruppe 1: n = 108), intermediäres plazentares und systemisches BV aufgrund einer intrakardialen Vermischung (Gruppe 2: n = 103), hohes plazentares BV (Gruppe 3: n = 13) und schließlich niedriges plazentares BV mit zudem geringer Sauerstoffzufuhr zum Gehirn ohne Vermischung (Gruppe 4: n = 24). Weiterhin wurde Gruppe 1 unterteilt in Feten mit antegradem (n = 34) und retrograden (n = 74) Fluss durch den Aortenbogen. Der Vergleich zwischen den CHD-Untergruppen erfolgte bei einem GA von 22, 30 bzw. 38 Schwangerschaftswochen (SSW).

Ergebnisse Die geschätzten Werte des zKU (z-Score transformiert) unterschieden sich nicht signifikant zwischen den 4 CHD-Gruppen (p > 0,05). Gruppe-1-Feten mit retrogradem Fluss im Aortenbogen zeigten einen signifikant negativen Zusammenhang zwischen zKU und GA im Vergleich zu den Referenzwerten (b = –0,054, p < 0,001). Im Alter von 38 SSW hatten Feten mit retrogradem Fluss signifikant niedrigere zKU-Werte (–0,836) im Vergleich zu solchen mit antegradem Fluss (0,366, p = 0,009).

Schlussfolgerung Unsere Resultate zeigen, dass CHD-Feten nicht allgemein signifikant geringere KU-Werte aufweisen. Der KU wird mit zunehmenden GA kleiner, abhängig von der Richtung des Flusses im Aortenbogen.

Key words

congenital heart disease - fetal head biometry - placental blood content - fetal echocardiography

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