Fetal cerebral vascular impedance is abnormal in left congenital diaphragmatic hernia.

Fetal cerebral vascular impedance is abnormal in left congenital diaphragmatic hernia. Ultrasound Obstet Gynecol. 2020 Feb 18;: Authors: Kosiv KA, Moon-Grady A, Hogan W, Keller R, Rapoport R, Rogers E, Feldstein VA, Lee H, Peyvandi S Abstract OBJECTIVES: Congenital diaphragmatic hernia (CDH) can cause significant mass effect in the fetal thorax displacing the heart into the opposite hemithorax. In left CDH (L-CDH), this is associated with smaller left-sided cardiac structures and lower left ventricular cardiac output (LVCO). The effect of these physiologic changes on cerebral blood flow is not well understood. We sought to describe the middle cerebral artery pulsatility index (MCA PI), a measure of vascular impedance, in L-CDH and right CDH (R-CDH) versus unaffected fetuses, and the relationship of MCA PI to LVCO. We hypothesized that MCA PI is lower in L-CDH and similar in R-CDH compared to controls. We further hypothesized that MCA PI would be correlated with LVCO. METHODS: We identified all fetuses with CDH at UCSF from 2011 to 2018. Fetal echocardiograms and ultrasounds were reviewed. Umbilical artery (UA) and middle cerebral artery (MCA) Dopplers were measured to calculate pulsatility indices. Ventricular outputs were calculated using Doppler derived stroke volume and fetal heart rate. Lung-to-head ratio (LHR), estimated fetal weight, biparietal diameter (BPD) and head circumference (HC) were obtained from fetal sonograms. A subset of survivors...
Source: The Ultrasound Review of Obstetrics and Gynecology - Category: Radiology Authors: Tags: Ultrasound Obstet Gynecol Source Type: research

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