Assessment of regional cerebral blood flow perfusion in fetuses with congenital heart diseases by three-dimensional power Doppler ultrasound

Objective To investigate the regional cerebral blood flow perfusion in fetuses with congenital heart disease (CHD) by three-dimensional power Doppler ultrasound (3D PD). Methods The vascular index (VI), flow index (FI) and vascular/flow index (VFI) in the main arterial territories [middle cerebral artery (MCA), anterior cerebral artery(ACA) and posterior cerebral artery (PCA)] were prospectively compared in 112 fetuses with CHD and 112 normal fetuses using 3D PD. Correlations between the 3D PD indices and neurodevelopment scores were assessed. Results Compared with the controls, the VI, FI and VFI of the three main arteries were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS) and left sided obstructive lesions (LSOL) (P<0.001). The mean psychomotor development index (PDI) and mental development index (MDI) scores were significantly lower than normal (P<0.001). ACA VI and ACA VFI were positively correlated with PDI (r=0.377, P=0.015 and r=0.389, P=0.012, respectively) but were not correlated with MDI. Conclusions Cerebral blood flow perfusion in three main arteries was significantly increased in fetuses with HLHS/LSOL, and blood flow perfusion in ACA area was significantly increased in fetuses with TGA. ACA-VI, ACA-FI had association with neurodevelopment scores. 3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling. Key words: Ultrasonography, prenatal; Heart defects, congenital; Cerebral blood perfusion