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Published on: July 18, 2014
Head Biometry in Fetuses with Isolated Congenital Heart Disease
Oliver Graupner1, Jessica Koch2, Christian Enzensberger2
1Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Germany.
Insights
Congenital heart disease (CHD) in fetuses does not generally lead to smaller head circumference (HC). However, retrograde aortic arch flow is linked to decreasing HC throughout gestation.
Area of Science:
- Fetal Medicine
- Pediatric Cardiology
- Medical Imaging
Background:
- Altered cerebral hemodynamics are implicated in head biometry changes in fetuses with congenital heart disease (CHD).
- Understanding fetal head growth patterns in relation to specific CHD types is crucial for accurate prenatal assessment.
Purpose of the Study:
- To compare head circumference (HC) growth in fetuses with different types of congenital heart disease (CHD).
- To investigate differences in HC development over gestational age (GA) among various CHD subgroups.
- To compare fetal head growth against established normative values.
Main Methods:
- Retrospective cohort study of 248 fetuses diagnosed with CHD.
- Subgrouping based on ascending aorta oxygen saturation and blood content (BC) related to oxygen delivery.
- Analysis of head circumference (HC) z-scores at 22, 30, and 38 weeks of gestational age (GA).
- Specific comparison of antegrade versus retrograde aortic arch flow within a low oxygen delivery group.
Main Results:
- No significant differences in estimated zHC values were observed between the four main CHD groups at any gestational age.
- Fetuses with retrograde aortic arch flow exhibited a significant negative association between HC and GA.
- At 38 weeks, fetuses with retrograde flow had significantly lower zHC values compared to those with antegrade flow.
Conclusions:
- The study does not support the general notion that fetuses with CHD universally have smaller head circumferences.
- The direction of aortic arch flow significantly influences head circumference development throughout gestation in fetuses with CHD.
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.
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