Autoregulation of cerebral blood flow in fetuses with congenital heart disease: The brain sparing effect
Autoregulation of cerebral blood flow in fetuses with congenital heart disease: The brain sparing effect
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DOI：
10.1007/s00246-002-0404-0
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发表时间：
2003-09-01
影响因子：
1.6
通讯作者：
Kleinman, CS
中科院分区：
文献类型：
--
作者：
Donofrio, MT;Bremer, YA;Kleinman, CS
患有先天性心脏病（CHD）的胎儿存在循环异常，可能会影响脑氧输送。我们认为，一些脑氧供应减少的CHD胎儿具有血流自动调节功能，可增强脑灌注（脑保护）。我们假设CHD胎儿存在脑自动调节，其程度取决于CHD的具体类型，并与胎儿宫内头围相关。将CHD胎儿与正常胎儿进行比较。数据包括心脏诊断、脑动脉和脐动脉多普勒、头围、体重和胎龄。评估脑-胎盘阻力比（CPR）作为脑自动调节的指标。CPR =脑/脐阻力指数（RI），RI =收缩期舒张/收缩期流速（正常CPR > 1）。CPR > 1在95%的正常胎儿和44%的CHD胎儿中发现。CPR < 1的发生率在左或右心发育不良的胎儿中最高。与正常胎儿相比，CHD胎儿脑RI降低。CPR与胎龄的关系，以及体重、头围和CPR之间的关系在正常胎儿和CHD胎儿中存在差异。患有CHD且CPR < 1的胎儿体重> 2 kg，头围小于正常。脑保留发生在CHD胎儿中。单心室生理的胎儿受影响最大。CHD胎儿的脑血流不足，尽管有自动调节，可能会改变大脑的生长。
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.