Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Maternal hyperoxia increases cerebral oxygenation
in fetuses with complex congenital heart disease:
a functional MRI study...
Congenital Heart Disease (CHD) and Brain Injury
❖ Background
– CHD impairs fetal brain development due to insufficient oxy...
Study Objective
❖ Objective
To compare placental and fetal brain
hemodynamic response to maternal hyperoxia,
between CHD v...
Functional MRI
Neural activity BOLD signal
Deoxyhemoglobin BOLD contrast
depends on the content of oxygen
(deoxyhemoglobin...
Methods
Brain
Placenta
Normoxia
2 min
Hyperoxia (100% O2)
4 min
Post-normoxia
3:30 min
o 1.5T GE MR scanner
o Echo planar ...
Fetal Brain/Placenta Data Processing
ROI
averaging
Motion
correction
ROI
splitting
Statistical
analysis
Raw EPI
ROI
averag...
Study Subjects
Control CHD
N=85 51 34
Mean GA
at MRI (wks)
32 (22-39) 32 (26-38)
❖ Cohort
❖ Inclusion Criteria
• Healthy p...
Study Cohort
Control CHD
N=85 51 34
Mean GA at MRI (wks) 32 (22-39) 32 (26-38)
Single ventricle (1V) 14
HLHS 12
Single LV ...
Results: Averaged BOLDTime Courses
Normoxia
2 min
Hyperoxia (100% O2)
4 min
Post-normoxia
3:30 min
-20%
-10%
0%
10%
20%
30...
Percent Changes in Oxygenation from Baseline
Type Hyperoxia Return to normoxia
Placenta Control 3.7±3.1 (*) 3.9±2.7 (*)
CH...
Hyperoxygenation: Control vs CHD
0%
1%
2%
3%
4%
5%
6%
7%
Early
hyperoxia (HO)
Late HO Early return
normoxia (NO)
Late retu...
Hyperoxygenation: 1V vs 2V
0%
1%
2%
3%
4%
5%
6%
7%
Early hyperoxia
(HO)
Late HO Early return
normoxia (NO)
Late return NO
...
Hyperoxygenation: CHD subgroup analyses
0%
1%
2%
3%
4%
5%
6%
7%
Late Hyperoxia
(HO)
Late return
normoxia (NO)
PercentSigna...
Hyperoxic Oxygen Saturation Curve
70
100
130
160
190
220
250
0% 20% 40% 60% 80% 100%
Saturationtime(second) Saturation rat...
Relationship of Placental and Cerebral Oxygenation
Placenta-fetal brain in hyperoxia
BOLD percent signal changes
Control :...
Relationship of Oxygenation and GA
Placenta Fetal Brain
Control : +0.8%/wk (p=0.1)
CHD : +1.5%/wk (p=0.04)
Control : +0.2%...
Relationship of Hyperoxygenation and Basal Condition
Placental BOLD vs UA-PI Cerebral BOLD vs UA-PI
Control : p=0.001
CHD ...
UA-PI: Control vs CHD
R²= 0.2879
R²= 0.2823
0.0
0.5
1.0
1.5
2.0
24 26 28 30 32 34 36 38 40
UA-PI
Gestational age (weeks)
C...
Relationship of BOLD and Doppler Ultrasound Measures
BOLD in hyperoxia
Control CHD
Placenta Brain Placenta Brain
Isthmus 0...
Summarized Conclusion from Ultrasound-fMRI Study
Healthy CHD
Change in cerebral
hyperoxygenation
insignificant
significant...
Conclusion
• This study provides the first evidence on the effect of
maternal hyperoxia on cerebral oxygenation in CHD fet...
Acknowledgement
❖ Collaborators
Catherine Limperopoulos, PhD Marine Bouyssi-Kobar
Adre du Plessis, MD Samantha Bauer
Josep...
Upcoming SlideShare
Loading in …5
×

Maternal hyperoxia increases cerebral oxygenation in fetuses with complex congenital heart disease: a functional MRI study

335 views

Published on

Fetal brain growth is altered in congenital heart disease (CHD). The role of disturbed placental and fetal blood flow/oxygenation remains poorly understood. We compared the effect of maternal hyperoxia on cerebral and placental oxygenation in CHD vs control fetuses using blood oxygenation level dependent (BOLD) functional MRI (fMRI).

Published in: Science
  • Be the first to comment

Maternal hyperoxia increases cerebral oxygenation in fetuses with complex congenital heart disease: a functional MRI study

  1. 1. Maternal hyperoxia increases cerebral oxygenation in fetuses with complex congenital heart disease: a functional MRI study WonsangYou, Mary Donofrio, David Wessel, Zungho Zun, Josepheen De Asis-Cruz, Gilbert Vezina, Dorothy Bulas, Richard Jonas, Adre du Plessis, Catherine Limperopoulos
  2. 2. Congenital Heart Disease (CHD) and Brain Injury ❖ Background – CHD impairs fetal brain development due to insufficient oxygen supply. – Placenta is critical for normal brain development. ❖ Unsolved problems – The mechanism by which CHD disrupts fetal brain development – The role of placenta in brain injury ❖ Recent studies – Changes in normal fetal brain & placental oxygenation during maternal hyperoxia, using fMRI. – But, hyperoxygenation in CHD, not examined through fMRI.
  3. 3. Study Objective ❖ Objective To compare placental and fetal brain hemodynamic response to maternal hyperoxia, between CHD vs healthy fetuses, using blood oxygenation level dependent (BOLD) functional MRI ❖ Hypothesis Maternal hyperoxia would reveal different oxygenation changes in the fetal brain between CHD vs control fetuses. Brain Placenta O2 Heart
  4. 4. Functional MRI Neural activity BOLD signal Deoxyhemoglobin BOLD contrast depends on the content of oxygen (deoxyhemoglobin) in blood vessels modulated by neural tissues . Neural activity is convolved by hemodynamics in fMRI. Blood-oxygen-level dependent 𝑂2 Hemodynamics
  5. 5. Methods Brain Placenta Normoxia 2 min Hyperoxia (100% O2) 4 min Post-normoxia 3:30 min o 1.5T GE MR scanner o Echo planar imaging (EPI)
  6. 6. Fetal Brain/Placenta Data Processing ROI averaging Motion correction ROI splitting Statistical analysis Raw EPI ROI averaging Motion correction Fetal brain Placenta Data imputation Data imputation Defining ROI masks
  7. 7. Study Subjects Control CHD N=85 51 34 Mean GA at MRI (wks) 32 (22-39) 32 (26-38) ❖ Cohort ❖ Inclusion Criteria • Healthy pregnant women/fetus with normal fetal echo (ECG) • Pregnant women/fetus who underwent a fetal ECG to confirm CHD ❖ Exclusion Criteria • Multiple gestations • Maternal contraindication to MRI • Congenital infection, dysmorphic features, dysgenetic brain legions, other anomalies by ultrasound • Chromosomal abnormalities by amniocentesis
  8. 8. Study Cohort Control CHD N=85 51 34 Mean GA at MRI (wks) 32 (22-39) 32 (26-38) Single ventricle (1V) 14 HLHS 12 Single LV 2 Two ventricles (2V) 20 dTGA 5 TOF 4 Ebstein’s malformation 4 DORV 3 VSD 2 CoA 1 AVCanal 1
  9. 9. Results: Averaged BOLDTime Courses Normoxia 2 min Hyperoxia (100% O2) 4 min Post-normoxia 3:30 min -20% -10% 0% 10% 20% 30% 40% 50% 0 100 200 300 400 500 PercentBOLDsignalchange Time (second) Brain Placenta Early HO Late HO Early return NO Late return NO
  10. 10. Percent Changes in Oxygenation from Baseline Type Hyperoxia Return to normoxia Placenta Control 3.7±3.1 (*) 3.9±2.7 (*) CHD 3.1±3.2 (*) 2.6±5.2 (*) 1-V 4.3±4.6 (*) 4.1±4.3 2-V 2.8±2.6 (*) 2.4±7.4 Brain Control 0.4±1.8 (*) 0.9±1.5 (*) CHD 0.8±2.0 2.9±3.0 (*) SV 1.1±1.3 3.4±2.4 (*) 2V 0.6±2.7 0.9±4.0 Unit. %
  11. 11. Hyperoxygenation: Control vs CHD 0% 1% 2% 3% 4% 5% 6% 7% Early hyperoxia (HO) Late HO Early return normoxia (NO) Late return NO PercentSignalChangeintheBrain Control CHD 0% 2% 4% 6% 8% 10% 12% 14% Beginning hyperoxia (HO) Late HO Early return normoxia (NO) Late return NOPercentSignalChangeinthePlacenta Control CHD * p=0.042 Fetal Brain Placenta
  12. 12. Hyperoxygenation: 1V vs 2V 0% 1% 2% 3% 4% 5% 6% 7% Early hyperoxia (HO) Late HO Early return normoxia (NO) Late return NO PercentSignalChangeintheBrain Control 2v 1v
  13. 13. Hyperoxygenation: CHD subgroup analyses 0% 1% 2% 3% 4% 5% 6% 7% Late Hyperoxia (HO) Late return normoxia (NO) PercentSignalChangeintheBrain Control 2V-CHD 1V-CHD *p=0.045 * p=0.045 3.3% -1.6% Single vsTwoVentricle CHD HLHS vsTGA
  14. 14. Hyperoxic Oxygen Saturation Curve 70 100 130 160 190 220 250 0% 20% 40% 60% 80% 100% Saturationtime(second) Saturation ratio Control CHD 70 100 130 160 190 220 250 0% 20% 40% 60% 80% 100% Saturationtime(second) Saturation ratio Control CHD • Fetal brain is saturated faster in CHD than in healthy controls (in 30~50%). Placenta Fetal Brain *
  15. 15. Relationship of Placental and Cerebral Oxygenation Placenta-fetal brain in hyperoxia BOLD percent signal changes Control : +1.37% in fetal brain for +10% in placenta (p=0.02) CHD : no significance (p=0.64)
  16. 16. Relationship of Oxygenation and GA Placenta Fetal Brain Control : +0.8%/wk (p=0.1) CHD : +1.5%/wk (p=0.04) Control : +0.2%/wk (p=0.03) CHD : +0.4%/wk (p=0.1)
  17. 17. Relationship of Hyperoxygenation and Basal Condition Placental BOLD vs UA-PI Cerebral BOLD vs UA-PI Control : p=0.001 CHD : p=0.04 Placenta BrainUA-PI Control : p=0.03 CHD : p=0.82 Placenta BrainUA-PI Control CHD
  18. 18. UA-PI: Control vs CHD R²= 0.2879 R²= 0.2823 0.0 0.5 1.0 1.5 2.0 24 26 28 30 32 34 36 38 40 UA-PI Gestational age (weeks) Control CHD
  19. 19. Relationship of BOLD and Doppler Ultrasound Measures BOLD in hyperoxia Control CHD Placenta Brain Placenta Brain Isthmus 0.001> (***) 0.001> (***) 0.699 0.798 UA-RI 0.002 (**) 0.027 (*) 0.268 0.614 UA-PI 0.002 (**) 0.027 (*) 0.343 0.863 CPR 0.065 0.034 (*) 0.455 0.995 MCA-RI 0.530 0.521 0.672 0.464 CCO/wt 0.831 0.895 0.605 0.994 BOLD in post-normoxia Control CHD Placenta Brain Placenta Brain Isthmus 0.115 0.003 (**) 0.986 0.561 UA-RI 0.358 0.060 0.098 (*) 0.823 UA-PI 0.368 0.063 0.148 0.723 CPR 0.716 0.198 0.043 (*) 0.676 MCA-RI 0.689 0.883 0.321 0.679 CCO/wt 0.843 0.574 0.716 0.975
  20. 20. Summarized Conclusion from Ultrasound-fMRI Study Healthy CHD Change in cerebral hyperoxygenation insignificant significantly elevated for 1V-CHD fetuses Relationship of cerebral oxygenation with placenta oxygenation significant Insignificant Effects of basal condition of placental circulation on cerebral oxygenation significant Insignificant
  21. 21. Conclusion • This study provides the first evidence on the effect of maternal hyperoxia on cerebral oxygenation in CHD fetuses. • Maternal hyperoxia significantly transiently increases cerebral oxygenation in the CHD fetuses with 1V. • But, cerebral oxygenation becomes less dependent to placental circulation in CHD fetuses, probably due to the increased resistance by cardiac abnormality as well as retrograde isthmus flow.
  22. 22. Acknowledgement ❖ Collaborators Catherine Limperopoulos, PhD Marine Bouyssi-Kobar Adre du Plessis, MD Samantha Bauer Josepheen Cruz, MD PhD Sonia Dahdouh, PhD Wesley Zun, PhD Diane Lanham Iordanis Evangelou, DPhil Caitlyn Loucas Mary Donofrio, MD Eman Mahdi, PhD Nickie Andescavage, MD Geraldine Pluviose Gilbert Vezina, MD Robbie Reese Dorothy Bulas, MD LauraTinkleman Shuo-Tse Hsu , MD Yao Wu, PhD Kushal Kapse Bernard Scalise ❖ Grant Funding NHLBI R01 (HL116585-01) National Institutes of Health CIHR (MOP-81116) Canadian Institutes of Health ❖ Families Nurses, Participant families

×