Assessment of cerebellum volume growth in fetuses with congenital heart disease by three-dimensional ultrasonography

Abstract

Objective To assess the cerebellum volume growth in fetuses with congenital heart disease (CHD). Methods The cerebellum volume (CV) were compared prospectively in 168 normal fetuses and 73 fetuses with CHD using 3D ultrasound combined with VOCAL software at 20-36+ 6 weeks of gestation. The differences in fetal brain volumes at each gestational week were analyzed using a Wilcoxon rank sum test to determine the timing of volumetric reduction. Multiple regression analyses were performed to identify risk factors for volume reduction in the groups. Results From the 28th week of gestation onwards, cerebellum volumes were progressively smaller in CHD fetuses relative to controls (P<0.01). The multivariable analysis showed that the diagnostic category (R2=0.852, P<0.001) was independently associated with smaller cerebellum volumes in fetuses with CHD. The highest ratios occurred in hypoplastic left heart syndrome (HLHS), followed by aorta hypoplasia, transposition of the great arteries (TGA) and tetralogy of Fallot (TOF). Conclusions The cerebellum volume growth is impaired in fetuses with complex CHD, particularly in those with HLHS, aorta hypoplasia or TGA. This study highlights a need for routine brain screening and early intervention to improve neurodevelopmental outcomes in fetuses with complex CHD. Key words: Ultrasonography, prenatal; Heart defects, congenital; Cerebellum