Cerebrovascular response to maternal hyperoxygenation in fetuses with hypoplastic left heart syndrome depends on gestational age and baseline cerebrovascular resistance.
Cerebrovascular response to maternal hyperoxygenation in fetuses with hypoplastic left heart syndrome depends on gestational age and baseline cerebrovascular resistance.
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DOI：
10.1002/uog.18919
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Rychik J
中科院分区：
文献类型：
--
作者：
Szwast A;Putt M;Gaynor JW;Licht DJ;Rychik J
与正常胎儿相比，左心发育不良综合征(HLHS)胎儿的脑体积较小，脑损伤的风险更高，这可能是由于脑血流和氧气含量减少所致。通过增加脑氧供应，母体高氧(MH)可能会促进这些胎儿的大脑发育，降低脑损伤的风险。这项研究调查了胎龄和基线脑血管阻力是否影响HLHS胎儿对MH的反应。研究人群包括43名患有HLHS或HLHS变异的胎儿，他们在2004年1月至2008年9月期间接受了胎儿超声心动图检查。测定胎龄20~41周的胎鼠大脑中动脉(MCA)搏动指数(PI)，作为脑血管阻力的替代指标。产生MCA-PI的Z-分数。使用混合效应模型来确定MCA-PI的变化是否取决于胎龄和基线MCA-PI。在RA和随后的MH中，HLHS胎儿的MCA-PI与胎龄呈曲线关系，在28周左右达到峰值，然后在短期内下降得更快。MCA-PI Z-Score呈线性下降，38周时比正常胎儿低1.4SD。MH后MCA-PIZ-Score增加首次见于≥28周。基线MCA-PI Z-Score≤−为0.96时预测MH后脑血管阻力增加。在HLHS的胎儿中，MCA-PI在≥妊娠28周时首次对MH产生反应。基线MCA-PI Z-Score≤−为0.96时，预测MH后脑血管阻力增加。这些结果可能对使用MH作为神经保护剂的临床试验有意义。
Compared with normal fetuses, fetuses with hypoplastic left heart syndrome (HLHS) have smaller brain volumes and are at higher risk of brain injury, possibly due to diminished cerebral blood flow and oxygen content. By increasing cerebral oxygen delivery, maternal hyperoxygenation (MH) might improve brain development and reduce the risk of brain injury in these fetuses. This study investigated whether gestational age and baseline cerebrovascular resistance affect the response to MH in fetuses with HLHS. The study population comprised 43 fetuses with HLHS or HLHS variant referred for fetal echocardiography between January 2004 and September 2008. Middle cerebral artery (MCA) pulsatility index (PI), a surrogate measure of cerebrovascular resistance, was assessed between 20 and 41 weeks’ gestation at baseline in room air (RA) and after 10 min of MH. Z-scores of MCA-PI were generated. A mixed-effects model was used to determine whether change in MCA-PI depends upon gestational age and baseline MCA-PI. In RA and following MH, MCA-PI demonstrated a curvilinear relationship with gestational age in fetuses with HLHS, peaking at around 28 weeks and then falling more steeply near term. MCA-PI Z-score declined in a linear manner, such that it was 1.4 SD below that in normal fetuses at 38 weeks. Increase in MCA-PI Z-score after MH was first seen at ≥ 28 weeks. A baseline MCA-PI Z-score ≤ −0.96 was predictive of an increase in cerebrovascular resistance in response to MH. In fetuses with HLHS, MCA-PI first increases in response to MH at ≥ 28 weeks’ gestation. A baseline MCA-PI Z-score ≤ −0.96 predicts an increase in cerebrovascular resistance in response to MH. These results may have implications for clinical trials utilizing MH as a neuroprotective agent.
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发育不全左心综合征的产前头部生长和白质损伤。
影响因子：
3.6
作者：
Hinton RB;Andelfinger G;Sekar P;Hinton AC;Gendron RL;Michelfelder EC;Robitaille Y;Benson DW
通讯作者：
Benson DW
DOI：
10.1016/j.jtcvs.2003.09.053
发表时间：
2004-03-01
影响因子：
6
作者：
Galli, KK;Zimmerman, RA;Gaynor, JW
通讯作者：
Gaynor, JW
DOI：
10.3174/ajnr.a4716
发表时间：
2016-07
期刊：
AJNR. American journal of neuroradiology
影响因子：
--
作者：
Brossard-Racine M;du Plessis A;Vezina G;Robertson R;Donofrio M;Tworetzky W;Limperopoulos C
通讯作者：
Limperopoulos C
影响因子：
37.8
作者：
Limperopoulos C;Tworetzky W;McElhinney DB;Newburger JW;Brown DW;Robertson RL Jr;Guizard N;McGrath E;Geva J;Annese D;Dunbar-Masterson C;Trainor B;Laussen PC;du Plessis AJ
通讯作者：
du Plessis AJ
影响因子：
158.5
作者：
Miller, Steven P.;McQuillen, Patrick S.;Vigneron, Daniel B.
通讯作者：
Vigneron, Daniel B.