Strong heart, fit brainCardiac impact on brain development in fetuses with congenital diaphragmatic hernia: A prospective cohort study

Purpose CDH fetuses may present with abnormal brain volume and cerebral fissures. Since cardiac function and size may also be altered, we hypothesized that abnormal cardiac function may contribute to the impaired brain development in these fetuses. The aim of this study is to evaluate whether cardiac dimensions and function correlate with brain development in CDH fetuses. Materials and Methods All fetuses with left CDH who underwent ultrasound evaluation of cardiac function and brain development between 2018 and 2023 were included. We analyzed the correlation between cardiac size and function parameters with the parieto-occipital (POF) and Sylvian (SF) fissures and insular depth (ID) in 2 gestational periods (GP). Cardiac and brain anatomical measures were corrected for head circumference, and cardiac function parameters were corrected for estimated fetal weight or GA. Correlations were analyzed using the Pearson test. A p-value <0.05 was considered significant. Results 24 fetuses with left CDH were included. Between 20 and 24 weeks of gestation, POF, SF, and ID were significantly correlated with aortic flow. Right ventricle E/A was significantly correlated with POF and SF, with a trend toward a correlation with ID, approaching the threshold of significance. In this GP, the ID was also significantly correlated with the left ventricle area, E/A, and E', S' and A'. Most correlations were lost in the next GP. Conclusion Between 20 and 24 weeks of gestation, brain development in fetuses with CDH is significantly correlated with cardiac function. Most of these correlations were lost at 25-28 weeks of gestation. Further studies are needed to confirm our results and to evaluate whether these findings have postnatal clinical significance.