Reduced fetal cerebral oxygen consumption is associated with smaller brain size in fetuses with congenital heart disease

Liqun Sun, Christopher K. Macgowan, John G. Sled, Shi Joon Yoo, Cedric Manlhiot, Prashob Porayette, Lars Grosse-Wortmann, Edgar Jaeggi, Brian W. McCrindle, John Kingdom, Edward Hickey, Steven Miller, Mike Seed

Research output: Contribution to journalArticlepeer-review

236 Scopus citations

Abstract

Background - Fetal hypoxia has been implicated in the abnormal brain development seen in newborns with congenital heart disease (CHD). New magnetic resonance imaging technology now offers the potential to investigate the relationship between fetal hemodynamics and brain dysmaturation. Methods and Results - We measured fetal brain size, oxygen saturation, and blood flow in the major vessels of the fetal circulation in 30 late-gestation fetuses with CHD and 30 normal controls using phase-contrast magnetic resonance imaging and T2 mapping. Fetal hemodynamic parameters were calculated from a combination of magnetic resonance imaging flow and oximetry data and fetal hemoglobin concentrations estimated from population averages. In fetuses with CHD, reductions in umbilical vein oxygen content (P<0.001) and failure of the normal streaming of oxygenated blood from the placenta to the ascending aorta were associated with a mean reduction in ascending aortic saturation of 10% (P<0.001), whereas cerebral blood flow and cerebral oxygen extraction were no different from those in controls. This accounted for the mean 15% reduction in cerebral oxygen delivery (P=0.08) and 32% reduction cerebral VO2 in CHD fetuses (P<0.001), which were associated with a 13% reduction in fetal brain volume (P<0.001). Fetal brain size correlated with ascending aortic oxygen saturation and cerebral VO2 (r=0.37, P=0.004). Conclusions - This study supports a direct link between reduced cerebral oxygenation and impaired brain growth in fetuses with CHD and raises the possibility that in utero brain development could be improved with maternal oxygen therapy.

Original languageEnglish (US)
Pages (from-to)1313-1323
Number of pages11
JournalCirculation
Volume131
Issue number15
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • Brain
  • Heart diseases
  • Hemodynamics
  • Magnetic resonance imaging
  • Pediatrics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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