Postnatal cerebral hemodynamics and placental vascular malperfusion lesions in neonates with congenital heart disease

Abstract

BackgroundNeonates with congenital heart disease (CHD) have smaller brain volume at birth. High rates of placental vascular malperfusion lesions may play a role in disrupted brain development. ObjectiveTo describe cerebral artery Doppler resistive indices (RI) in neonates with CHD in the early postnatal period and to determine association with placental vascular malperfusion lesions. MethodsThis is a single-center retrospective cohort study of infants born between 2010 and 2019 who were diagnosed with a major cardiac defect requiring surgery in the first year of life. Doppler ultrasound resistive indices (RI) of the middle cerebral arteries (MCA) and anterior cerebral artery (ACA) were calculated within the first 72 hours of life. Placentas were evaluated using a standardized approach. ResultsOver the study period, there were 52 patients with hypoplastic left heart syndrome (HLHS), 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 Doppler RI were significantly higher for all subgroups of CHD compared to controls (0.68 ± 0.11 control compared to 0.78 ± 0.13 in HLHS; p=0.03, 0.77 ± 0.10 in SV-RVOT Obstruction; p=0.002, 0.78 ± 0.13 in 2V; p=0.03, 0.80 ± 0.14 in TGA; p=0.001) with the highest average MCA RI in the TGA group. In subgroup analyses, placental fetal vascular malperfusion in the 2V group was associated with higher MCA RI, but this relationship was not present in other subgroups, nor in regards to maternal vascular malperfusion. ConclusionMajor forms of CHD are associated with significantly higher cerebral artery RI postnatally but placental vascular malperfusion lesions may not contribute to this hemodynamic adaptation.