Autoregulation of Cerebral Blood Flow in Fetuses with Congenital Heart Disease: The Brain Sparing Effect
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.
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Abnormal cerebral blood flow has been documented in fetuses and newborns with complex anomalies such as hypoplastic left heart syndrome.
“Several studies have documented abnormal cerebral blood flow in fetuses and newborns with complex anomalies such as hypoplastic left heart syndrome (HLHS) [12,20,21].”
From Brain Volume and Metabolism in Fetuses With Congenital Heart Disease: Evaluation With Quantitative Magnetic Resonance Imaging and Spectroscopy (2010) · cites this paper as [20]
In transposition of the great arteries, the aorta connects to the right ventricle, disrupting preferential streaming of oxygenated blood across the foramen ovale and lowering oxygen and nutrient delivery to the brain.
“In transposition of the great arteries (TGA), the aorta is connected to the right ventricle, disrupting the normal preferential streaming of oxygenated blood across the foramen ovale (Fig. 1, TGA), resulting in lower oxygen and nutrient delivery to the brain.27”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [27]
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- Authors
- Donofrio, M. T., Bremer, Y. A., Schieken, R. M., Gennings, C., Morton, L. D., Eidem, B. W., Cetta, F., Falkensammer, C. B., Huhta, J. C., & Kleinman, C. S.
- Affiliations
- Virginia Commonwealth University (US)
- Loyola University Medical Center (US)
- Columbia University (US)
- Corresponding author
- Donofrio, M. T.
- Venue
- Pediatric Cardiology
- Published
- 2003-09-01
- Volume
- 24
- Issue
- 5
- Pages
- 436-443
- ISSN
- 0172-0643 (ISSN-L)
- 1432-1971
- OpenAlex
- W1977425029
- Cited by
- 364
- References
- 20
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 18 · 2023: 23 · 2022: 16 · 2021: 24 · 2020: 22 · 2019: 23 · 2018: 23 · 2017: 22 · 2016: 17 · 2015: 17 · 2014: 13 · 2013: 13 · 2012: 9
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Pediatric Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
- Keywords
- cerebral autoregulation, congenital heart disease, brain sparing effect, cerebral blood flow, cerebral oxygen delivery, umbilical artery resistance index, fetal head circumference, fetal brain development, single ventricle, hypoplastic left heart syndrome, hypoplastic right heart syndrome, fetal hemodynamics
- MeSH terms
- Blood Flow Velocity, Cerebral Arteries, Cerebrovascular Circulation, Echocardiography, Fetus, Gestational Age, Head, Heart Diseases, Humans, Prospective Studies
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