title: Evidence of second-trimester changes in head biometry and brain perfusion in fetuses with congenital heart disease.
abstract: OBJECTIVE
  To evaluate the associations between congenital heart disease (CHD) and head biometry and cerebrovascular blood flow dynamics at the time of diagnosis of CHD in the second trimester of pregnancy.
  
  
  METHODS
  This was a study of 95 consecutive fetuses diagnosed with CHD. At the time of diagnosis, fetal biometry was performed and brain perfusion was assessed by middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR) and fractional moving blood volume (FMBV). The results were compared with those of 95 normal fetuses matched for gestational age.
  
  
  RESULTS
  Median gestational age at diagnosis was 22 + 3 (range, 20 + 0 to 23 + 5) weeks. Fetuses with CHD showed significantly lower MCA-PI and CPR Z-scores (-0.23 vs 0.34 and -0.37 vs 0.30, respectively; both P < 0.001) and higher FMBV Z-scores (2.35 vs 0.15; P < 0.001). FMBV > 95(th) percentile was observed in 81.1% of cases as compared with 10.5% in controls (P < 0.001). Moreover, cases showed significantly smaller biparietal diameter (BPD) and head circumference (HC) Z-scores (-1.61 vs -0.43 and -0.89 vs 0.09, respectively; both P < 0.001), with a higher proportion of BPD and HC measurements below the 5(th) percentile compared with controls (51.6% vs 13.7% and 26.3% vs 4.2%, respectively; both P < 0.001). These findings were more pronounced in those cases with types of CHD associated with compromised oxygenated blood delivery to the brain, such as left outflow tract obstruction and transposition of the great arteries.
  
  
  CONCLUSIONS
  A high proportion of fetuses with CHD have a smaller head and increased brain perfusion already in the second trimester, suggesting an early onset of the mechanisms leading to poorer neurodevelopment later in life.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Masoller
authors.forename: J M
authors.initials: JM
authors.lastname: Martínez
authors.forename: O
authors.initials: O
authors.lastname: Gómez
authors.forename: M
authors.initials: M
authors.lastname: Bennasar
authors.forename: F
authors.initials: F
authors.lastname: Crispi
authors.forename: M
authors.initials: M
authors.lastname: Sanz-Cortés
authors.forename: G
authors.initials: G
authors.lastname: Egaña-Ugrinovic
authors.forename: J
authors.initials: J
authors.lastname: Bartrons
authors.forename: B
authors.initials: B
authors.lastname: Puerto
authors.forename: E
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000328:Adult; D001699:Biometry / Q000379:methods; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply* / Q000196:embryology*; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006257:Head / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000196:embryology*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000196:embryology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second
keywords: brain perfusion; congenital heart defect; echocardiography; head biometry; second trimester