{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:10:38Z","timestamp":1790482238303,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2004,12,8]],"date-time":"2004-12-08T00:00:00Z","timestamp":1102464000000},"content-version":"vor","delay-in-days":0,"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":[[2005,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Neurological abnormalities are present in some children after repair of congenital heart disease (CHD). Recently, structural brain abnormalities have been identified in infants prior to cardiac surgery. By altering\n                      <jats:italic>in utero<\/jats:italic>\n                      blood flow patterns, the type of CHD may impact upon cerebrovascular flow dynamics prior to birth. We sought to determine whether left\u2010 and right\u2010sided obstructive congenital heart lesions modify cerebrovascular flow dynamics in the fetus.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pulsed Doppler was used to measure blood flow velocities in the umbilical (UA) and middle cerebral (MCA) arteries in 172 fetuses from 20 to 39 weeks' gestational age referred for fetal echocardiography. Pulsatility index (PI), an indicator of downstream vascular resistance, was determined by (peak systolic velocity\u2014end\u2010diastolic velocity)\/mean velocity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fetuses with hypoplastic left heart syndrome (HLHS;\n                      <jats:italic>n<\/jats:italic>\n                      = 28) had decreased MCA\u2010PI (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009) compared to normal fetuses (\n                      <jats:italic>n<\/jats:italic>\n                      = 114). Fetuses with right\u2010sided obstructive lesions (RSOL;\n                      <jats:italic>n<\/jats:italic>\n                      = 17) had increased MCA\u2010PI (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001) when compared to fetuses with HLHS. The UA\u2010PI was elevated in fetuses with RSOLs (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.045).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cerebrovascular resistance is lower than normal in fetuses with HLHS, a condition in which cerebral perfusion occurs retrograde via the ductus arteriosus. Fetuses with RSOL had significantly higher cerebrovascular resistance compared to fetuses with HLHS. The type of CHD impacts upon fetal cerebrovascular blood flow distribution and this may have implications for later development of neurological sequelae. Copyright \u00a9 2004 ISUOG. Published by John Wiley &amp; Sons, Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.1785","type":"journal-article","created":{"date-parts":[[2004,12,8]],"date-time":"2004-12-08T13:33:39Z","timestamp":1102512819000},"page":"32-36","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":257,"title":["Impact of congenital heart disease on cerebrovascular blood flow dynamics in the fetus"],"prefix":"10.1002","volume":"25","author":[{"given":"J. R.","family":"Kaltman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Di","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Rychik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,12,8]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199310073291501"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.100.5.526"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.5.1082"},{"issue":"1","key":"e_1_2_6_5_2","first-page":"109","article-title":"An MRI study of neurological injury before and after congenital heart surgery","volume":"106","author":"Mahle WT","year":"2002","journal-title":"Circulation"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-994202"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.85.6.984"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.103.2.402"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2003.mpd0340"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2003.mpd0354"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-002-0404-0"},{"key":"e_1_2_6_12_2","first-page":"61","volume-title":"Arteries and Veins","author":"Gosling RG","year":"1975"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1986.tb07932.x"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-199203000-00018"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1990.18.3.165"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.8.883"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2000.108952"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(74)90587-0"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-197401000-00009"},{"key":"e_1_2_6_20_2","first-page":"71","article-title":"Distribution and recirculation of umbilical and systemic venous blood flow in fetal lambs during hypoxia","volume":"2","author":"Reuss ML","year":"1980","journal-title":"J Dev Physiol"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1990.tb02573.x"},{"key":"e_1_2_6_22_2","first-page":"705","article-title":"Cerebral and umbilical arterial blood flow velocity waveforms in normal and growth\u2010retarded pregnancies","volume":"69","author":"Wladimiroff JW","year":"1987","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(93)90156-D"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(96)00062-2"},{"key":"e_1_2_6_25_2","first-page":"724","article-title":"Preferential streaming of ductus venosus blood to the brain and heart in fetal lambs","volume":"237","author":"Edelstone DI","year":"1979","journal-title":"Am J Physiol"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2001.00397.x"}],"container-title":["Ultrasound in Obstetrics &amp; 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