Pediatric Cardiology

, Volume 24, Issue 5, pp 436–443

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

  • M. T. Donofrio
  • Y. A. Bremer
  • R. M. Schieken
  • C. Gennings
  • L. D. Morton
  • B. W. Eidem
  • F. Cetta
  • C. B. Falkensammer
  • J. C. Huhta
  • C. S. Kleinman
Original Article

DOI: 10.1007/s00246-002-0404-0

Cite this article as:
Donofrio, M., Bremer, Y., Schieken, R. et al. Pediatr Cardiol (2003) 24: 436. doi:10.1007/s00246-002-0404-0

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.

Keywords

Congenital heart defects Fetal circulation Cerebrovascular circulation Fetal echocardiography 

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • M. T. Donofrio
    • 1
  • Y. A. Bremer
    • 1
  • R. M. Schieken
    • 1
  • C. Gennings
    • 1
  • L. D. Morton
    • 1
  • B. W. Eidem
    • 2
  • F. Cetta
    • 2
  • C. B. Falkensammer
    • 3
  • J. C. Huhta
    • 3
  • C. S. Kleinman
    • 4
  1. 1.Medical College of Virginia Hospital of the Virginia Commonwealth University, Box 980342 Richmond, VA 23298USA
  2. 2.Loyola University Medical Center, Maywood, IL 60153USA
  3. 3.Tampa Children’s Hospital, Tampa, FL 33607USA
  4. 4.Columbia UniversityBabies and Children’s Hospital, New York, NY 10032USA