Frontal Lobe Growth Impairment in Fetuses with Congenital Heart Disease Using Ultrasound Parameters; A Comparative Cross-Sectional Study

Abstract Background There is evidence; in neonates with critical congenital heart disease CHD, that the abnormal hemodynamics do not affect all brain regions similarly, with the frontal lobe growth being more severely impaired, especially in cases with univentricular heart anatomy. Aim and Objectives To assess whether fetuses with congenital heart disease (CHD) have smaller frontal brain areas compared with normal controls. Subjects and Methods This Cross-sectional study was conducted at Ain Shams University Maternity Hospital (Fetal Medicine unit). The study group included 280 women, 140 women whose fetuses are normal and the other 140 women whose fetuses suffered congenital heart disease using ultrasonography. Measuring the distance from the internal edge of the frontal bone to the posterior edge of the CSP (measured in-to-in), i.e the frontal lobe anteroposterior diameter (FAPD), which was assumed to be representative of the area of the frontal lobes; measuring of the occipitofrontal diameter (OFD), (also measured in-to-in), from the internal edge of the frontal bone to the internal edge of the occipital bone. The ratio of these two measurements, calculated as FAPD/OFD×100 and referred to as ‘FAPD/OFD ratio’, represents the reference index that was used in this investigation to assess the growth of the frontal component of the fetal brain in relation to the growth of the whole brain. Fetal echocardiography was done for both groups to assess the cardiac anomalies. Result There was a statistically significant difference between the studied groups regarding History of CHD. the FAPD/OFD ratio was significantly smaller in both the group of left-heart lesion or univentricular heart and the group of all other CHDs, compared with normal fetuses (P < 0.0001), with no statistically significant difference between the two CHD groups. There was no statistically significant difference between the studied groups regarding comparison between surgical history, co-morbidities and Correlation of frontal anteroposterior diameter (FAPD), occiptofrontal diamter (OFD) and FAPD/OFD ratio with the other studied parameters in all cases except in gestational age and CNS anomalies. Conclusion Fetuses with CHD have a shorter FAPD and a smaller FAPD/OFD ratio compared to normal fetuses. This impaired growth of the frontal area of the brain seems to occur in all types of CHD, regardless of their impact on the hemodynamics.