Impaired cerebral development in fetuses with congenital cardiovascular malformations: Is it the result of inadequate glucose supply?
Abstract
Cerebral development may be impaired in fetuses with congenital cardiovascular malformations, particularly hypoplastic left heart syndrome (HLHS) and aortopulmonary transposition (APT). The decreased cerebral arterial pusatility index observed in some of these fetuses led to the belief that cerebral vascular resistance was reduced as a result of arterial hypoxemia and cerebral hypoxia is thought to be responsible for impaired cerebral growth. However, other hemodynamic factors could affect pulsatility index. I propose that cerebral blood flow is reduced in fetuses with HLHS and that reduced glucose, rather than oxygen, delivery interferes with cerebral development. This is based on the fact that most of these fetuses do not have lactate accumulation in the brain.In fetuses with APT, umbilical venous blood, containing oxygen and glucose derived across the placenta, is distributed to the lungs and lower body; venous blood, with low oxygen and glucose content, is delivered to the ascending aorta and brain. Oxygen and glucose delivery may further be reduced by decreased cerebral blood flow resulting from run-off of aortic blood through the ductus arteriosus to the pulmonary circulation during diastole. In APT fetuses, lack of lactate in the brain also supports my proposal that glucose deficiency interferes with cerebral development.
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Chronic hypoxia likely makes brain development suboptimal, and decreased nutrient delivery such as glucose should also be considered a contributor to brain dysmaturation.
“It is understandable that brain development will be suboptimal under conditions of chronic hypoxia, while decreased nutrient delivery (e.g.glucose) should also be considered as a contributor to brain dysmaturation.29”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [29]
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- Authors
- Rudolph, A. M.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Rudolph, Abraham M.
- Venue
- Pediatric Research
- Published
- 2016-04-07
- Volume
- 80
- Issue
- 2
- Pages
- 172-177
- ISSN
- 0031-3998 (ISSN-L)
- 1530-0447
- OpenAlex
- W2325043769
- Cited by
- 55
- References
- 29
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 8 · 2018: 5 · 2017: 4
- FWCI
- 5.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Research (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 › Neonatal and fetal brain pathology
- Keywords
- congenital cardiovascular malformations, hypoplastic left heart syndrome, cerebral blood flow, glucose delivery, cerebral hypoxia, cerebrovascular resistance, umbilical venous blood, lactate, ductus arteriosus, fetal hemodynamics
- MeSH terms
- Hypoxia, Aorta, Blood Glucose, Body Weight, Brain, Brain Diseases, Cardiovascular System, Cerebrovascular Circulation, Female, Gestational Age, Glucose, Heart Defects, Congenital, Hemodynamics, Humans, Organ Size, Oxygen, Pregnancy, Time Factors, Umbilical Arteries, Hypoplastic Left Heart Syndrome, Middle Cerebral Artery
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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