Fetal cerebrovascular response to maternal hyperoxygenation in congenital heart disease: effect of cardiac physiology.
Fetal cerebrovascular response to maternal hyperoxygenation in congenital heart disease: effect of cardiac physiology.
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DOI：
10.1002/uog.22024
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Peyvandi S
中科院分区：
文献类型：
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作者：
Hogan WJ;Moon-Grady AJ;Zhao Y;Cresalia NM;Nawaytou H;Quezada E;Brook M;McQuillen P;Peyvandi S
胎儿脑血管阻力受几个因素的影响，在设置完整的自动调节，以允许正常的脑血流量和氧合。母体高氧（MH）测试允许胎儿生理的急性改变，可以是一个工具，以测试脑血管反应性在妊娠晚期胎儿。我们利用MH试验来评估患有特殊先天性心脏病（CHD）的胎儿的脑血管反应性。这项横断面研究比较了患有复杂冠心病的胎儿和没有冠心病的对照组。冠心病患者按生理分组：左侧梗阻性病变（LSOL）、右侧梗阻性病变（RSOL）和d-大动脉转位（d-TGA）。受试者在妊娠晚期胎儿超声心动图期间进行MH检测。计算大脑中动脉（MCA）、脐动脉（UA）和肺动脉分支（PA）的脉搏指数（PI）。在基线和随访时，将每个冠心病组与对照组进行比较。纳入60名孕妇（冠心病组，n= 43；对照组，n= 17）。LSOL 27例，RSOL 7例，d-TGA 9例。平均胎龄为33.9周（95% CI: 33.6-34.2）。基线时，与对照组（- 0.8,95% CI: - 1.3, 0.3）相比，LSOL组的MCA PI z评分最低（- 1.8,95% CI: - 2.4, - 1.2）。在MH的作用下，对照组和d-TGA组的MCA PI z评分显著升高，而LSOL组保持不变，RSOL组下降。对照组MCA PI Z-score的变化显著高于LSOL组（control= 0.9, 95% CI: 0.42, 1.4； LSOL= 0.12, 95% CI: - 0.21, 0.45; p= 0.03）。这种差异在主动脉弓血流逆行的LSOL亚组中更为明显。在所有组中，PA PI与MH以相同的速率下降，UA PI不变。胎儿脑血管对MH的反应因潜在冠心病诊断而异，提示心血管生理可能影响胎儿大脑的自我调节能力。需要进一步的研究来确定这些发现对这些高危儿童的长期神经发育的临床意义。
Fetal cerebral vascular resistance is influenced by several factors in the setting of intact autoregulation to allow for normal cerebral blood flow and oxygenation. Maternal hyperoxia (MH) testing allows for acute alterations in fetal physiology and can be a tool to test cerebral vascular reactivity in late gestation fetuses. We utilized MH testing to evaluate cerebral vascular reactivity in fetuses with specific congenital heart disease (CHD). This cross-sectional study compares fetuses with complex CHD to controls without CHD. CHD cases were grouped by physiology: left-sided obstructive lesion (LSOL), right-sided obstructive lesion (RSOL), and d-transposition of the great arteries (d-TGA). Subjects underwent MH testing during the 3rd trimester fetal echocardiogram. The pulsatility index (PI) was calculated for the middle cerebral artery (MCA), umbilical artery (UA) and branch pulmonary artery (PA). Comparisons were made between each CHD group and the control group at baseline and following MH. 60 pregnant women enrolled (CHD, n= 43; Control, n= 17). There were 27 fetuses with LSOL, 7 with RSOL and 9 with d-TGA. Mean gestational age was 33.9 weeks (95% CI: 33.6-34.2). At baseline, the MCA PI Z-score was lowest in the LSOL group (−1.8, 95% CI: −2.4, −1.2) compared with the control group (−0.8, 95% CI: −1.3, 0.3). In response to MH, the MCA PI Z-score increased significantly in the control and d-TGA groups but remained unchanged in the LSOL group and declined in the RSOL group. The change in MCA PI Z-score was significantly higher in the control group than the LSOL group (control= 0.9, 95% CI: 0.42, 1.4; LSOL= 0.12, 95% CI: −0.21, 0.45; p= 0.03). This difference was more pronounced in the LSOL subgroup with retrograde aortic arch flow. In all groups, the PA PI decreased at the same rate with MH and the UA PI was unchanged. The fetal cerebral vascular response to MH varies based on underlying CHD diagnosis, suggesting that cardiovascular physiology may influence autoregulatory capacities of the fetal brain. Further studies are needed to determine clinical implications of these findings on long-term neurodevelopment in these at-risk children.
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DOI：
10.1002/uog.18919
发表时间：
2018-10
期刊：
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
影响因子：
--
作者：
Szwast A;Putt M;Gaynor JW;Licht DJ;Rychik J
通讯作者：
Rychik J
影响因子：
24
作者：
Peyvandi S;Chau V;Guo T;Xu D;Glass HC;Synnes A;Poskitt K;Barkovich AJ;Miller SP;McQuillen PS
通讯作者：
McQuillen PS
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：
3.1
作者：
Regan, Rosemary E.;Fisher, Joseph A.;Duffin, James
通讯作者：
Duffin, James
DOI：
10.7863/ultra.32.6.1067
发表时间：
2013-06-01
期刊：
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
影响因子：
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作者：
通讯作者：
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