Longitudinal analysis of head and somatic growth in fetuses with congenital heart defects.
OBJECTIVE
Fetal head and somatic growth dynamics differs in fetuses with congenital heart defects (CHD). We longitudinally characterized fetal head and somatic growth in relation to the type of CHD.


METHODS
Four hundred eleven exams from isolated CHD were compared with 1,219 controls. Head and somatic growth was assessed using head circumference (HC), brain volume (BrV = 1/6 × π × (HC/π)3)/2), fetal cephalization index (FCI = BrV/[estimated fetal weight]), and growth percentile. Umbilical and middle cerebral artery Doppler indices were obtained. CHD were grouped as: (1) d-transposition of great arteries (n = 11); (2) left ventricular outflow tract obstruction with retrograde isthmic flow (n = 18); (3) left ventricular outflow tract obstruction with antegrade isthmic flow (n = 16); (4) pulmonary outflow tract obstructions (n = 22).


RESULTS
The smallest head size was seen in group 1. Growth asymmetry was diagnosed in group 2. Brain sparing was seen in groups 2 and 4 (p < 0.0001). HC and BrV percentiles decreased with advancing gestational age (p < 0.001) in group 2, and a significant drop was observed around 28 weeks.


CONCLUSIONS
d-Transposition of great arteries and left-sided CHD leading to isthmic blood flow reversal are associated with delayed head growth. Prenatal evaluation of central hemodynamics in CHD may be contributive for predicting neurodevelopmental risks in CHD and help directing prenatal interventions. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:96-104, 2017.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 6th Floor, Room 6NE11, 22 South Greene Street, Baltimore, MD, 21201.
Sifa
S
Turan
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 6th Floor, Room 6NE11, 22 South Greene Street, Baltimore, MD, 21201.
Joshua I
JI
Rosenbloom
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 6th Floor, Room 6NE11, 22 South Greene Street, Baltimore, MD, 21201.
Mostafa
M
Hussein
Department of Obstetrics and Prenatal Medicine, Friedrich Wilhelm University, Bonn, Germany.
Christoph
C
Berg
Department of Obstetrics and Prenatal Medicine, Friedrich Wilhelm University, Bonn, Germany.
Ulrich
U
Gembruch
Center for Fetal Therapy, Johns Hopkins University, Baltimore, MD.
Ahmet A
AA
Baschat
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 6th Floor, Room 6NE11, 22 South Greene Street, Baltimore, MD, 21201.
Ozhan M
OM
Turan
D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D047109:Fetal Development; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000196:embryology*; D006801:Humans; D008137:Longitudinal Studies; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology; D011247:Pregnancy; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000196:embryology / Q000503:physiopathology
Doppler indices; congenital heart defects; growth pattern