title: Cardiac Findings in the Fetus with Cerebral Arteriovenous Malformation Are Associated with Adverse Outcome.
abstract: OBJECTIVE
  To assess cardiac sequelae of fetal cerebral arteriovenous malformations (CAVMs) and evaluate any association with outcomes.
  
  
  METHODS
  We retrospectively analyzed cardiac structure and function in fetuses with CAVMs who underwent fetal echocardiography (October 1999 to August 2015, n = 11), and compared them with normal controls.
  
  
  RESULTS
  The median gestational age was 36 weeks (range 18-38). Common abnormal findings included dilated superior vena cava (100%) and right atrium (82%), reduced middle cerebral artery pulsatility index (86%), tricuspid regurgitation (82%), and right ventricular (RV) dysfunction (64%). Hydrops was present in 1 fetus, who did not survive. The median cardiothoracic ratio (CTR) was 0.36 (0.29-0.45, n = 10); the median combined cardiac output indexed to estimated fetal weight (iCCO) was 565 ml/kg/min (379-1,565, n = 7). Of the 11 fetuses, 1 patient elected for termination, and 5 suffered neonatal demise. Comparing survivors (n = 5) and nonsurvivors (n = 6), a larger tricuspid valve (TV) z-score (p = 0.009) and RV dysfunction (p = 0.015) were associated with nonsurvival, and nonsurvivors had a higher iCCO than controls (990 vs. 550 ml/kg/min, p = 0.035). A larger difference between the TV and mitral valve z-scores (surrogate for RV dilation, p = 0.052), and CTR >0.38 (p = 0.0762) tended towards nonsurvival.
  
  
  CONCLUSIONS
  CAVMs impose volume load on the fetal circulation, mainly affecting right heart structures. Increased right heart dilation and dysfunction are associated with nonsurvival.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston Mass., USA.
authors.forename: Max E
authors.initials: ME
authors.lastname: Godfrey
authors.forename: Wayne
authors.initials: W
authors.lastname: Tworetzky
authors.forename: Donna
authors.initials: D
authors.lastname: Morash
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Friedman
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging