Author + information
- Jayani Abeysekera,
- Dora Gyenes,
- Charlene Robertson,
- Gwen Alton,
- Irina Dinu,
- Dianne Creighton,
- Joseph Atallah,
- Ivan Rebeyka and
- Lisa Hornberger
Background: Children with congenital heart disease are at increased risk of adverse long-term neurodevelopmental outcomes believed in part secondary to a prenatal insult. Altered fetal middle cerebral arterial (MCA) Dopplers suggestive of brain sparing (low Pulsatility Index, PI) as well as placental pathology have been documented in fetal heart disease. In this study, we investigated the relationship between MCA and umbilical arterial, UA, flow patterns in fetal transposition of the great arteries (TGA) and hypoplastic left heart syndrome (HLHS) on growth and 2-year neurodevelopmental outcomes.
Methods: We identified children with d-TGA and HLHS within the Western Canadian Complex Pediatric Therapies Follow-Up Program who had a 3rd trimester fetal echocardiogram between October 2004 and August 2014. Participants with inadequate fetal Doppler data or death prior to 2-year follow-up were excluded. MCA and UA PI measurements were obtained via offline analysis of 3rd trimester fetal echocardiograms. The relationship with birth and 2 year somatic measures, and 2 year Bayley Scales of Infant and Toddler Development III composite scores were analyzed using two-sided Pearson correlations (r).
Results: Children with d-TGA (n=24) and HLHS (n=36) were included. MCA PI did not correlate with birth somatic measures or 2-year neurodevelopmental outcomes. UA PI, however, inversely correlated birth and 2 year head circumference (r=-0.36, p=0.005 and r=-0.25, p=0.05), length (r=-0.27, p=0.039 and r=-0.40, p=0.001) and weight (r=-0.31, p=0.015 and r=-0.44, p=0.001), and 2-year cognitive (r=-0.30, p=0.019), language (r=-0.30, p=0. 022) and motor scores (r=-0.27, p=0.04).
Conclusions: A higher UA PI, suggestive of placental insufficiency, in fetal HLHS and d-TGA is associated with worse 2-year growth and neurodevelopmental outcomes. This could represent an additional insult that contributes to long-term outcomes in critical neonatal heart disease. Understanding these risk factors allows for early identification and intervention to ultimately improve outcomes and decrease disease burden.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 4:00 p.m.-4:10 p.m.
Session Title: Impact of Prenatal Environment on Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1259M-05
- 2017 American College of Cardiology Foundation