{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T02:52:04Z","timestamp":1782442324182,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,9,2]],"date-time":"2013-09-02T00:00:00Z","timestamp":1378080000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Decreased middle cerebral artery (<jats:styled-content style=\"fixed-case\">MCA<\/jats:styled-content>) pulsatility index (<jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>) is a marker of fetal brain\u2010sparing in placental insufficiency and it is also found in fetuses with severe congenital heart disease. This study sought to explore the impact of anatomical subtypes in fetal heart disease on <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content> and head growth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed fetal echocardiograms of pregnancies complicated by fetal hypoplastic left heart syndrome (<jats:styled-content style=\"fixed-case\">HLHS<\/jats:styled-content>; <jats:italic>n<\/jats:italic>\u2009=\u200942) with and without anatomic coarctation (<jats:italic>n<\/jats:italic>\u2009=\u200928 and <jats:italic>n<\/jats:italic>\u2009=\u200910, respectively), isolated severe aortic coarctation (<jats:italic>n<\/jats:italic>\u2009=\u200921), D\u2010transposition of the great arteries (<jats:styled-content style=\"fixed-case\">TGA<\/jats:styled-content>; <jats:italic>n<\/jats:italic>\u2009=\u200911) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (<jats:styled-content style=\"fixed-case\">POTO<\/jats:styled-content>; <jats:italic>n<\/jats:italic>\u2009=\u200915), comparing observations with gestational age\u2010matched controls (<jats:italic>n<\/jats:italic>\u2009=\u200989). No fetus had major extracardiac pathology or aneuploidy. <jats:styled-content style=\"fixed-case\">MCA<\/jats:styled-content> and umbilical artery (<jats:styled-content style=\"fixed-case\">UA<\/jats:styled-content>) <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>, the cerebral placental ratio (<jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content> \u2009=\u2009 <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content>\/ <jats:styled-content style=\"fixed-case\">UA\u2010PI<\/jats:styled-content>) and neonatal head circumference were obtained and expressed as <jats:italic>Z<\/jats:italic>\u2010scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Lower <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content>, higher <jats:styled-content style=\"fixed-case\">UA\u2010PI<\/jats:styled-content> and lower <jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content> were observed in fetal <jats:styled-content style=\"fixed-case\">HLHS<\/jats:styled-content> and isolated coarctation with reversed arch flow (<jats:italic>n<\/jats:italic>\u2009=\u20096) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) but not <jats:styled-content style=\"fixed-case\">TGA<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">POTO<\/jats:styled-content> or isolated coarctation with antegrade arch flow (<jats:italic>n<\/jats:italic>\u2009=\u200915) compared with controls. No difference was found between <jats:styled-content style=\"fixed-case\">HLHS<\/jats:styled-content> with anatomical coarctation and those without; however, <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content> correlated positively with neonatal head circumference in <jats:styled-content style=\"fixed-case\">HLHS<\/jats:styled-content> with reversed distal arch flow (<jats:italic>r<\/jats:italic>\u2009=\u20090.33, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Severe left heart obstruction with reversed aortic arch flow is associated with altered fetal cerebral blood flow, and in these conditions, <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content> positively correlates with head growth. Anatomical arch obstruction itself may not be a contributing factor to altered <jats:styled-content style=\"fixed-case\">MCA<\/jats:styled-content> flow in fetal <jats:styled-content style=\"fixed-case\">HLHS<\/jats:styled-content>. Copyright \u00a9 2013 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.12448","type":"journal-article","created":{"date-parts":[[2013,3,2]],"date-time":"2013-03-02T07:17:35Z","timestamp":1362208655000},"page":"294-299","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow"],"prefix":"10.1002","volume":"42","author":[{"given":"Y.","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology Women's &amp; Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. S.","family":"Khoo","sequence":"additional","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology Women's &amp; Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. A.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology Women's &amp; Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Savard","sequence":"additional","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology Women's &amp; Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Hirose","sequence":"additional","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology Women's &amp; Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. K.","family":"Hornberger","sequence":"additional","affiliation":[{"name":"Fetal &amp; Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology Women's &amp; Children's Health Research Institute and Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.05.045"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2010.547961"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7474"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-002-0404-0"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1785"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2009.09.004"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11147"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/359390"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4088"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.21115"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.966"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0301-5629(92)90095-R"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(98)00320-0"},{"key":"e_1_2_6_16_1","article-title":"Placental abnormalities in fetal congenital heart disease","volume":"124","author":"Goff DA","year":"2011","journal-title":"Circulation"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.11.032"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1966.210.2.287"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2002.00756.x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.25.6.651"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(74)90587-0"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.865568"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.12448","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.12448","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T10:19:26Z","timestamp":1696501166000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.12448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2013,9]]}},"alternative-id":["10.1002\/uog.12448"],"URL":"https:\/\/doi.org\/10.1002\/uog.12448","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9]]},"assertion":[{"value":"2012-10-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-02-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-09-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}