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Autoregulation of Cerebral Blood Flow in Fetuses with Congenital Heart Disease: The Brain Sparing Effect

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Abstract

Fetuses with congenital heart disease (CHD) have circulatory abnormalities that may compromise cerebral oxygen delivery. We believe that some CHD fetuses with decreased cerebral oxygen supply have autoregulation of blood flow that enhances cerebral perfusion (brain sparing). We hypothesize that cerebral autoregulation occurs in CHD fetuses, and the degree of autoregulation is dependent on the specific CHD and correlates with intrauterine head circumferences. CHD fetuses were compared to normal fetuses. Data included cardiac diagnosis, cerebral and umbilical artery Doppler, head circumference, weight, and gestational age. The cerebral-to-placental resistance ratio (CPR) was assessed as a measure of cerebral autoregulation. CPR = cerebral/umbilical resistance index (RI) and RI = systolic–diastolic/systolic velocity (normal CPR>1). CPR>1 was found in 95% of normal vs 44% of CHD fetuses. The incidence of CPR<1 was greatest in hypoplastic left or right heart fetuses. Compared to normal, cerebral RI was decreased in CHD fetuses. The CPR vs gestational age relationship, and the relationship among weight, head circumference, and CPR differed across normal and CHD fetuses. Fetuses > 2 kg with CHD and a CPR<1 had smaller head circumferences than normal. Brain sparing occurs in CHD fetuses. Fetuses with single ventricular physiology are most affected. Inadequate cerebral flow in CHD fetuses, despite autoregulation, may alter brain growth.

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Acknowledgements

We are grateful to Cathy Dickens and Beverly Hairston for their expert technical support and to Dr. Lisa Troyer for her thoughtful advice and guidance. Statistical assistance was supplied by the Clinical Research Center at Virginia Commonwealth University. Funds to support a collaborative planning meeting were supplied by a grant from the American Pediatric Society and Society for Pediatric Research.

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Authors and Affiliations

  1. Medical College of Virginia Hospital of the Virginia Commonwealth University, Box 980342 Richmond, VA 23298, USA

    M. T. Donofrio, Y. A. Bremer, R. M. Schieken, C. Gennings & L. D. Morton

  2. Loyola University Medical Center, Maywood, IL 60153, USA

    B. W. Eidem & F. Cetta

  3. Tampa Children’s Hospital, Tampa, FL 33607, USA

    C. B. Falkensammer & J. C. Huhta

  4. Columbia University, Babies and Children’s Hospital, New York, NY 10032, USA

    C. S. Kleinman

Authors
  1. M. T. Donofrio
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  2. Y. A. Bremer
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  3. R. M. Schieken
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  4. C. Gennings
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  5. L. D. Morton
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  6. B. W. Eidem
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  7. F. Cetta
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  8. C. B. Falkensammer
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  9. J. C. Huhta
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  10. C. S. Kleinman
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Correspondence to M. T. Donofrio.

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Donofrio, M., Bremer, Y., Schieken, R. et al. Autoregulation of Cerebral Blood Flow in Fetuses with Congenital Heart Disease: The Brain Sparing Effect . Pediatr Cardiol 24, 436–443 (2003). https://doi.org/10.1007/s00246-002-0404-0

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  • DOI: https://doi.org/10.1007/s00246-002-0404-0

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