Effects of congenital heart disease on fetal growth and neurodevelopment: evaluation of fetuses in the second and third trimesters of gestation

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Abstract
Purpose: The aim of this study is to evaluate the neurodevelopmental prognosis of fetuses with congenital heart defects by considering aortic flow and oxygen saturation in the ascending aorta, and to investigate them in terms of cortical developmental delay.Materials and Methods: In this retrospective study, neurosonographic and hemodynamic parameters were measured in fetuses diagnosed with congenital heart defects. These measurements were compared with those of gestational-age-matched low-risk controls in the second and third trimesters. Standard fetal biometry, transcerebellar diameter, Sylvian fissure area, and related ratios were evaluated.Results: The study included 53 fetuses with congenital heart defects and 72 controls in the second trimester, and 72 fetuses with congenital heart defects and 58 controls in the third trimester. In the second trimester, the Sylvian fissure area was lower in the CHD group (50.98 ± 21.02 mm² vs 58.37 ± 16.41 mm²), while the HC/SYL ratio was higher in the CHD group in both the second trimester (4.53 ± 1.69 vs 3.44 ± 0.74) and the third trimester (2.71 ± 1.31 vs 2.09 ± 0.49). Neurodevelopmental parameters showed that the Sylvian fissure area was smaller in the second-trimester congenital heart defects group compared with controls. Consequently, the aortic valve diameter/Sylvian fissure area and head circumference/Sylvian fissure area ratios were higher in the congenital heart defects group. In the third trimester, patients with normal aortic flow and two functional ventricles had higher aortic valve diameter/Sylvian fissure area ratios than other patient groups. Conclusion: Detecting early-onset cortical developmental delay in patients with left cardiac dysfunction using proportional data is crucial for a holistic approach to evaluation. Incorporating head circumference/Sylvian fissure area and aortic valve diameter/Sylvian fissure area ratios into routine prenatal follow-up measurements may help identify fetuses at potential risk for adverse postnatal neurodevelopmental outcomes.

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