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Cardiac Findings in the Fetus with Cerebral Arteriovenous Malformation Are Associated with Adverse Outcome

Max E Godfrey1, Wayne Tworetzky, Donna Morash

  • 1Department of Cardiology, Children's Hospital Boston, Boston Mass., USA.

Fetal Diagnosis and Therapy
|June 4, 2016
PubMed

Insights

Fetal cerebral arteriovenous malformations (CAVMs) strain the fetal heart, particularly right-sided structures. Increased right heart dilation and dysfunction in fetuses with CAVMs are linked to poorer survival outcomes.

Area of Science:

  • Cardiology
  • Fetal Medicine
  • Neurology

Background:

  • Fetal cerebral arteriovenous malformations (CAVMs) are complex vascular anomalies.
  • The cardiac sequelae of CAVMs are not well understood.
  • Assessing cardiac impact is crucial for managing these high-risk pregnancies.

Purpose of the Study:

  • To evaluate cardiac structure and function in fetuses diagnosed with CAVMs.
  • To determine the association between cardiac findings and fetal/neonatal outcomes.

Main Methods:

  • Retrospective analysis of fetal echocardiograms in 11 fetuses with CAVMs.
  • Comparison of cardiac parameters with a control group.
  • Correlation of cardiac findings with survival and neonatal demise.

Main Results:

  • Fetuses with CAVMs commonly showed dilated superior vena cava and right atrium, reduced middle cerebral artery pulsatility index, tricuspid regurgitation, and right ventricular (RV) dysfunction.
  • Nonsurvivors exhibited a larger tricuspid valve z-score and RV dysfunction.
  • Higher indexed cardiac output was observed in nonsurvivors compared to controls.

Conclusions:

  • CAVMs induce a significant volume load on the fetal circulation.
  • Right heart dilation and dysfunction are key indicators of poor prognosis in fetuses with CAVMs.
  • Early identification of cardiac changes is vital for risk stratification.
Abstract

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