162: Congenital cardiac defects and placental vascular malperfusion

There is growing evidence that abnormal early angiogenesis impacts pathogenesis of maternal hypertensive disorders, fetal growth restriction and congenital heart defects (CHD). The aim of this retrospective case control study is to assess the frequency of placental vascular malperfusion in congenital heart defects. Singleton pregnancies with isolated fetal CHD and delivery after 32 weeks that necessitated intervention with catheterization and or surgery in the first year of life were recruited from the Pediatric Cardiology database from April 2016 to April 2019. A control group without any congenital anomalies or diabetes, chronic hypertension, gestational hypertension, or preeclampsia were recruited from the Pathology data base. CHD was classified as groups: 1. right single ventricle morphology, 2. left single ventricle morphology, 3. transposition of the great vessels (TGA), 4. other conotruncal CHD, and 5. other CHD. Placental histopathology was classified as fetal vascular malperfusion (FVM), maternal vascular malperfusion (MVM), both FVM and MVM and neither. Chi square and t test were used as appropriate for statistical analysis. There were 37 patients and 45 controls included in the study. The CHD group had a decreased birth weight (BW) as compared to the control group. Placental vascular malperfusion and fetal vascular malperfusion were significantly increased in the CHD cases (33 % vs 62 %, Table 1). When compared to other CHD groups combined, CHD Groups 1 and 2 had a trend for any vascular malperfusion (80% vs 50%, p=0.09), (Table 2). Placental malperfusion overall and FVM were increased in CHD. These findings suggest interactions of the fetal cardiac and placental development pathways.View Large Image Figure ViewerDownload Hi-res image Download (PPT)