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Published on: May 5, 2018
Cardiovascular Ultrasound Predictors for Brain Alterations in Fetuses With Heart Disease: An Exploratory Review of
María Alejandra Aguirre Martínez1, Luisa Fernanda Cano Bautista1, Mauricio Hernández-Carrillo2
1Resident in Obstetrics and Gynecology, Universidad Libre Seccional Cali, Cali, Colombia.
Insights
Cardiovascular ultrasound can predict fetal brain anomalies in fetuses with heart disease. Specific hemodynamic changes, like low aortic oxygen and altered flow patterns, correlate with reduced brain volume and maturation.
Area of Science:
- Cardiology
- Fetal Medicine
- Neurology
Background:
- Congenital heart disease (CHD) in fetuses can lead to central nervous system (CNS) anomalies.
- Early identification of these anomalies is crucial for management and outcomes.
Purpose of the Study:
- To identify cardiovascular ultrasound predictors of brain anomalies in fetuses diagnosed with heart disease.
- To correlate specific hemodynamic parameters with observed fetal brain changes.
Main Methods:
- A systematic literature search was conducted across multiple databases (MEDLINE, EMBASE, CENTRAL, LILACS) up to May 2023.
- Included studies encompassed clinical trials, cohort studies, and systematic reviews, with risk of bias assessed using QUADAS-2.
Main Results:
- Ten articles were selected, revealing associations between cardiovascular predictors and fetal brain anomalies.
- Key predictors included low ascending aorta oxygen content, retrograde aortic arch flow, altered middle cerebral artery (MCA-PI) and umbilical artery (UA-PI) pulsatility indices, and reduced cerebral perfusion ratio (CPR).
- Lower left ventricular flow, ductus arteriosus flow, and combined cardiac output index were also significant predictors.
Conclusions:
- Hemodynamic alterations in fetuses with heart disease contribute to chronic hypoxia.
- These hemodynamic changes are significantly correlated with adverse central nervous system outcomes, including reduced brain volume and delayed maturation.
Objective:
To identify cardiovascular ultrasound predictors for brain anomalies in fetuses with heart disease.
Methods:
A literature search was performed in the following databases: MEDLINE through OVID, EMBASE, Cochrane Registry Center for Controlled Trials (CENTRAL), and LILACS, from their inception until May 2023. Clinical studies, cross-sectional studies, case-control studies, cohorts, and systematic reviews were included. Data extraction was performed, and the risk of bias was assessed using the QUADAS-2 tool.
Results:
Among 2705 studies evaluated, after filtering information, 10 articles were selected that met the inclusion criteria. These studies noted the following outcomes: a decrease in fetal head circumference, changes in brain maturation measured in days, decreased depth of brain fissures, and a decrease in total brain volume. The studies show a statistically significant correlation with the presence of the following cardiovascular predictors: low or mixed oxygen content in the ascending aorta (p < 0.001), retrograde flow in the aortic arch (p < 0.001), lower z values of the MCA-PI (p < 0.05), higher UA-PI z values (p < 0.01), and lower CPR (p < 0.05). In addition, lower values of left ventricular flow (p < 0.01), ductus arteriosus (p < 0.0001), and combined cardiac output index (p < 0.01) were reported.
Conclusions:
This review describes the most relevant evidence correlating the effects of hemodynamic changes that lead to states of chronic hypoxia related to the aforementioned changes in the central nervous system.
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