BACKGROUND: Children with congenital heart disease are at risk for impaired neurodevelopment (ND). We investigated the association of fetal cerebrovascular resistance with ND in patients with single ventricle lesions. METHODS: In the Single Ventricle Reconstruction (SVR) and Infant Single Ventricle trials, 14-month ND was assessed using the Bayley Scales of Infant Development II. We investigated associations between ND scores and fetal middle cerebral artery pulsatility index (MCA-PI) z-scores, a Doppler-derived estimate of cerebrovascular resistance in a subset of those infants. RESULTS: Neurodevelopment assessments were performed at age 14.3 ± 1 months in 170 (74%) of 230 Infant Single Ventricle and 321 (58%) of 555 SVR subjects. Fetal echocardiographic data were available in 119 subjects, 72 (61%) of which had ND testing. Mean Psychomotor Development Index (PDI) (76 ± 20) and Mental Development Index (MDI) (89 ± 17) scores were lower than normative means (100 ± 15, P < .001). Mean MCA-PI z-score was -0.95 ± 1.52. Middle cerebral artery pulsatility index z-score correlated negatively with PDI (r = -0.27, P = .02) but was not associated with MDI. When MCA-PI z-score was added to a multivariable model controlling for factors identified in the SVR trial to predict PDI, the percentage of explained variation increased from 23% to 30%, and MCA-PI z-score remained an independent predictor (r = -3.864, P = .03). Middle cerebral artery pulsatility index z-score was not an independent predictor in a model adjusting for site. CONCLUSIONS: Among fetuses with single ventricle anomalies, lower cerebrovascular resistance was associated with higher ND scores. This relationship is opposite to that observed with advanced intrauterine growth retardation and may represent a unique ability of these congenital heart disease fetuses to compensate for diminished cerebral oxygen delivery.
BACKGROUND:Children with congenital heart disease are at risk for impaired neurodevelopment (ND). We investigated the association of fetal cerebrovascular resistance with ND in patients with single ventricle lesions. METHODS: In the Single Ventricle Reconstruction (SVR) and Infant Single Ventricle trials, 14-month ND was assessed using the Bayley Scales of Infant Development II. We investigated associations between ND scores and fetal middle cerebral artery pulsatility index (MCA-PI) z-scores, a Doppler-derived estimate of cerebrovascular resistance in a subset of those infants. RESULTS: Neurodevelopment assessments were performed at age 14.3 ± 1 months in 170 (74%) of 230 Infant Single Ventricle and 321 (58%) of 555 SVR subjects. Fetal echocardiographic data were available in 119 subjects, 72 (61%) of which had ND testing. Mean Psychomotor Development Index (PDI) (76 ± 20) and Mental Development Index (MDI) (89 ± 17) scores were lower than normative means (100 ± 15, P < .001). Mean MCA-PI z-score was -0.95 ± 1.52. Middle cerebral artery pulsatility index z-score correlated negatively with PDI (r = -0.27, P = .02) but was not associated with MDI. When MCA-PI z-score was added to a multivariable model controlling for factors identified in the SVR trial to predict PDI, the percentage of explained variation increased from 23% to 30%, and MCA-PI z-score remained an independent predictor (r = -3.864, P = .03). Middle cerebral artery pulsatility index z-score was not an independent predictor in a model adjusting for site. CONCLUSIONS: Among fetuses with single ventricle anomalies, lower cerebrovascular resistance was associated with higher ND scores. This relationship is opposite to that observed with advanced intrauterine growth retardation and may represent a unique ability of these congenital heart disease fetuses to compensate for diminished cerebral oxygen delivery.
Authors: 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 Journal: Pediatr Cardiol Date: 2003 Sep-Oct Impact factor: 1.655
Authors: C S Goldberg; E M Schwartz; J A Brunberg; R S Mosca; E L Bove; M A Schork; S P Stetz; J P Cheatham; T J Kulik Journal: J Pediatr Date: 2000-11 Impact factor: 4.406
Authors: I A Williams; A R Tarullo; P G Grieve; A Wilpers; E F Vignola; M M Myers; W P Fifer Journal: Ultrasound Obstet Gynecol Date: 2012-08-02 Impact factor: 7.299
Authors: William T Mahle; Federica Tavani; Robert A Zimmerman; Susan C Nicolson; Kristin K Galli; J William Gaynor; Robert R Clancy; Lisa M Montenegro; Thomas L Spray; Rosetta M Chiavacci; Gil Wernovsky; C Dean Kurth Journal: Circulation Date: 2002-09-24 Impact factor: 29.690
Authors: Cynthia M Ortinau; Caitlin K Rollins; Anjali Sadhwani; David Wypij; Valerie Rofeberg; Ali Gholipour; Maggie Mittleman; Julia Rohde; Clemente Velasco-Annis; Johanna Calderon; Kevin G Friedman; Wayne Tworetzky; P Ellen Grant; Janet S Soul; Simon K Warfield; Jane W Newburger Journal: Circulation Date: 2022-02-10 Impact factor: 29.690
Authors: K A Kosiv; A Moon-Grady; W Hogan; R Keller; R Rapoport; E Rogers; V A Feldstein; H Lee; S Peyvandi Journal: Ultrasound Obstet Gynecol Date: 2021-03 Impact factor: 7.299
Authors: David C Bellinger; Christopher G Watson; Michael J Rivkin; Richard L Robertson; Amy E Roberts; Christian Stopp; Carolyn Dunbar-Masterson; Dana Bernson; David R DeMaso; David Wypij; Jane W Newburger Journal: J Am Heart Assoc Date: 2015-12-14 Impact factor: 5.501