Different vasodilatation characteristics among the main cerebral arteries in fetuses with congenital heart defects

Area of Science:

• Fetal Medicine
• Neurodevelopmental Pediatrics
• Cardiovascular Physiology

Background:

• Congenital heart defects (CHDs) can impact fetal brain development and neurodevelopmental outcomes.
• Cerebral artery Doppler indices, such as pulsatility index (PI), are used to assess fetal cerebral blood flow.
• Understanding these changes is crucial for predicting neurodevelopmental trajectories in affected fetuses.

Purpose of the Study:

• To investigate Doppler changes in the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) in fetuses with CHDs.
• To compare cerebral artery PI values between fetuses with CHDs and normal controls.
• To assess the correlation between cerebral artery PIs and neurodevelopmental scores (psychomotor development index [PDI] and mental development index [MDI]).

Main Methods:

• Prospective comparison of ACA, MCA, and PCA pulsatility index (PI) values in 78 fetuses with CHDs and 78 normal controls.
• Assessment of correlations between cerebral artery PIs and neurodevelopmental scores (PDI and MDI).
• Analysis of cerebral artery vasodilatation signs in relation to specific CHDs.

Main Results:

• Reduced MCA-PI was observed in fetuses with hypoplastic left heart syndrome (HLHS).
• Reduced ACA-PI and PCA-PI were noted in fetuses with HLHS and left-sided obstructive lesions (LSOLs).
• The ACA-PI showed stronger positive correlations with PDI and MDI scores compared to MCA-PI, suggesting greater sensitivity in predicting abnormal neurodevelopment.

Conclusions:

• Specific CHDs are associated with altered Doppler indices in major cerebral arteries.
• The anterior cerebral artery pulsatility index (ACA-PI) appears more sensitive than the middle cerebral artery pulsatility index (MCA-PI) for predicting adverse neurodevelopmental outcomes in fetuses with CHDs.
• Cerebral vasodilatation, particularly in the ACA, is more frequent and pronounced in certain CHDs, indicating potential fetal brain adaptation or compromise.