93 - Postnatal Cerebral Autoregulation and Placental Vascular Malperfusion in Fetuses Diagnosed with Congenital Heart Disease

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 93
Publication Number: 93.425

Rachel L.. Leon, University of Texas Southwestern Medical School, Dallas, TX, United States; Kavita Sharma, University of Texas Southwestern Medical School, Dallas, TX, United States; Imran N. Mir, University of Texas Southwestern Medical School, Plano, TX, United States; Lina Chalak, UT Southwestern.edu, DALLAS, TX, United States

Presenting Author(s)

RL

Rachel L. Leon, MD, PhD (she/her/hers)

Assistant Professor
University of Texas Southwestern Medical School
Dallas, Texas, United States

Background: Neonates with congenital heart disease (CHD) are known to have delayed brain maturation and smaller brain volume at birth. High rates of placental maternal vascular malperfusion (MVM) lesions and associated placental dysfunction may play a role in their disrupted fetal brain development due to decreased oxygen delivery and impaired cerebral autoregulation. Cerebral artery vasodilation in fetuses with CHD has been well described, but there is a lack of data on the effect of specific forms of cardiac physiology on cerebral hemodynamics, particularly after delivery in the early postnatal period.

Objective: To describe cerebral artery Doppler resistive indices (RI) in neonates with specific forms of cardiac physiology in the early postnatal period and to determine the association of cerebral artery RI with placental MVM lesions.

Design/Methods:

This is a single-center retrospective cohort study of infants born between 2010 and 2019 who were diagnosed during pregnancy with a major cardiac defect requiring surgical intervention in the first year of life. In CHD patients, Doppler ultrasound resistive indices (RI) of the bilateral middle cerebral arteries (MCA) and one anterior cerebral artery (ACA) were calculated within the first 72 hours of life. For healthy Controls, right MCA RI was obtained within the first day of life. Placentas were sampled and evaluated using the Amsterdam Placental Workshop Group Consensus Statement guidelines.

Results: Over the study period, there were 52 patients with single-ventricle left-ventricular outflow tract obstruction (SV-LVOTO), 22 with single-ventricle right-ventricular outflow tract obstruction (SV-RVOTO), 75 with a two-ventricle cardiac defect (2V), and 25 with transposition of the great arteries (TGA). MCA RI was significantly higher in all CHD groups compared to Controls (Table 1; 0.68 ± 0.11 compared to 0.78 ± 0.13 in SV-LVOTO, 0.77 ± 0.10 in SV-RVOTO, 0.78 ± 0.13 in 2V, 0.80 ± 0.14 in TGA; p=0.01). In the combined CHD group, there were 53 (29%) with placental MVM and 132 (71%) without MVM and no differences in MCA RI (Table 2; 0.78 ± 0.14 and 0.79 ± 0.15, respectively; p=0.82). In subgroup analysis, the presence of MVM was associated with a differential effect on cerebral artery RI depending on cardiac physiology (Table 3).

Conclusion(s): Major forms of CHD are associated with significantly higher cerebral artery RI postnatally, which may be indicative of impaired cerebral autoregulation.