Cardiovascular Ultrasound Predictors for Brain Alterations in Fetuses With Heart Disease: An Exploratory Review of the Literature

IF 1.6 4区医学 Q4 DEVELOPMENTAL BIOLOGY Birth Defects Research Pub Date : 2024-10-14 DOI:10.1002/bdr2.2402

María Alejandra Aguirre Martínez, Luisa Fernanda Cano Bautista, Mauricio Hernández-Carrillo, Armicson Felipe Solano Montero

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Abstract

Objective

To identify cardiovascular ultrasound predictors for brain anomalies in fetuses with heart disease.

Methods

A literature search was performed in the following databases: MEDLINE through OVID, EMBASE, Cochrane Registry Center for Controlled Trials (CENTRAL), and LILACS, from their inception until May 2023. Clinical studies, cross-sectional studies, case–control studies, cohorts, and systematic reviews were included. Data extraction was performed, and the risk of bias was assessed using the QUADAS-2 tool.

Results

Among 2705 studies evaluated, after filtering information, 10 articles were selected that met the inclusion criteria. These studies noted the following outcomes: a decrease in fetal head circumference, changes in brain maturation measured in days, decreased depth of brain fissures, and a decrease in total brain volume. The studies show a statistically significant correlation with the presence of the following cardiovascular predictors: low or mixed oxygen content in the ascending aorta (p < 0.001), retrograde flow in the aortic arch (p < 0.001), lower z values of the MCA-PI (p < 0.05), higher UA-PI z values (p < 0.01), and lower CPR (p < 0.05). In addition, lower values of left ventricular flow (p < 0.01), ductus arteriosus (p < 0.0001), and combined cardiac output index (p < 0.01) were reported.

Conclusions

This review describes the most relevant evidence correlating the effects of hemodynamic changes that lead to states of chronic hypoxia related to the aforementioned changes in the central nervous system.

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心血管超声预测患有心脏病的胎儿脑部变化：文献探索性综述

目的确定心血管超声预测心脏病胎儿脑异常的指标。方法在以下数据库中进行文献检索：MEDLINE through OVID、EMBASE、Cochrane Registry Center for Controlled Trials (CENTRAL) 和 LILACS。纳入了临床研究、横断面研究、病例对照研究、队列研究和系统综述。进行了数据提取，并使用 QUADAS-2 工具评估了偏倚风险。结果在评估的 2705 项研究中，经过信息筛选，选出了 10 篇符合纳入标准的文章。这些研究指出了以下结果：胎儿头围减小、以天数为单位的大脑成熟度变化、脑裂深度减小以及大脑总体积减小。这些研究显示，以下心血管预测因素与胎儿的存在有显著的统计学相关性：升主动脉氧含量低或混合（p < 0.001）、主动脉弓逆流（p < 0.001）、MCA-PI z 值低（p < 0.05）、UA-PI z 值高（p < 0.01）和心肺复苏率低（p < 0.05）。此外，左心室血流（p <0.01）、动脉导管（p <0.0001）和合并心输出量指数（p <0.01）的值也较低。结论本综述描述了最相关的证据，这些证据表明，导致慢性缺氧状态的血液动力学变化的影响与中枢神经系统的上述变化有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Birth Defects Research Medicine-Embryology

CiteScore

3.60

自引率

9.50%

发文量

153

期刊介绍： The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.