Abstract
Coarctation of the aorta (CoA) is a prevalent congenital heart defect. Its prenatal diagnosis is challenging, with high false positive rates. The exact cause of CoA is yet not fully understood. Recent research has provided novel insights into the anatomical determinants of CoA based on the in-utero arch anatomy. However, it is also recognized that the pathophysiology of CoA is also intrinsically linked to abnormal flow dynamics. To investigate the interplay between arch anatomy and flow, Computational Fluid Dynamics (CFD) analysis was performed in two fetal cases - a true and a false positive CoA. These anatomies were selected from a population of 108 fetuses with suspected CoA based on a statistical shape analysis score and clinical outcomes. A simplified 0D model of the fetal circulation informed by 2D PC-MRI was used to find patient-specific boundary conditions for an open-loop 3D-0D CFD model. Results from the 3D CFD models were validated against clinical imaging data for each case and provided initial evidence of hemodynamic differences between false positive and true positive CoA cases. These findings demonstrate the potential of using the SSM-guided CFD analysis on a larger cohort of representative cases to better understand the disease mechanisms in CoA and improve its diagnosis before birth.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Alimohammadi, M., Agu, O., Balabani, S., Díaz-Zuccarini, V.: Development of a patient-specific simulation tool to analyse aortic dissections: assessment of mixed patient-specific flow and pressure boundary conditions. Med. Eng. Phys. 36(3), 275–284 (2014). https://doi.org/10.1016/j.medengphy.2013.11.003
Bidhult, S., et al.: Independent validation of metric optimized gating for fetal cardiovascular phase-contrast flow imaging. Magn. Reson. Med. 81(1), 495–503 (2019). https://doi.org/10.1002/mrm.27392
Chen, Z., Liu, Z., Du, M., Wang, Z.: Artificial intelligence in obstetric ultrasound: an update and future applications. Front. Med. 8, 1–9 (2021). https://doi.org/10.3389/fmed.2021.733468
Chen, Z., Zhou, Y., Wang, J., Liu, X., Ge, S., He, Y.: Modeling of coarctation of aorta in human fetuses using 3D/4D fetal echocardiography and computational fluid dynamics. Echocardiography 34(12), 1858–1866 (2017). https://doi.org/10.1111/echo.13644
Familiari, A., et al.: Risk factors for coarctation of the aorta on prenatal ultrasound: a systematic review and meta-analysis. Circulation 135(8), 772–785 (2017). https://doi.org/10.1161/CIRCULATIONAHA.116.024068
Garcia-Canadilla, P., et al.: A computational model of the fetal circulation to quantify blood redistribution in intrauterine growth restriction. PLoS Comput. Biol. 10(6), 9–11 (2014). https://doi.org/10.1371/journal.pcbi.1003667
Hahn, C., Schwartz, M.A.: Mechanotransduction in vascular physiology and atherogenesis. Nat. Rev. Mol. Cell Biol. 10(1), 53–62 (2009). https://doi.org/10.1038/nrm2596
Hermida, U., et al.: Learning the hidden signature of fetal arch anatomy: a three-dimensional shape analysis in suspected coarctation of the aorta. J. Cardiovasc. Transl. Res. (2022). https://doi.org/10.1007/s12265-022-10335-9
Hutchins, G.M.: Coarctation of the aorta explained as a branch-point of the ductus arteriosus. Am. J. Pathol. 63(2), 203–214 (1971)
Iwaki, R., et al.: Evaluation of ductal tissue in coarctation of the aorta using X-ray phase-contrast tomography. Pediatr. Cardiol. 42(3), 654–661 (2021). https://doi.org/10.1007/s00246-020-02526-5
Jansz, M.S., et al.: Metric optimized gating for fetal cardiac MRI. Magn. Reson. Med. 64(5), 1304–1314 (2010). https://doi.org/10.1002/mrm.22542
Lloyd, D.F., et al.: Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: a prospective, single-centre cohort study. Lancet 393(10181), 1619–1627 (2019). https://doi.org/10.1016/S0140-6736(18)32490-5
Lloyd, D.F., Rutherford, M.A., Simpson, J.M., Razavi, R.: The neurodevelopmental implications of hypoplastic left heart syndrome in the fetus. Cardiol. Young 27(2), 217–223 (2017). https://doi.org/10.1017/S1047951116001645
Morris, P.D., et al.: Computational fluid dynamics modelling in cardiovascular medicine. Heart 102(1), 18–28 (2016). https://doi.org/10.1136/heartjnl-2015-308044
Roberts, T.A., et al.: Fetal whole heart blood flow imaging using 4D cine MRI. Nat. Commun. 11(1), 1–13 (2020). https://doi.org/10.1038/s41467-020-18790-1
Roux, E., Bougaran, P., Dufourcq, P., Couffinhal, T.: Fluid shear stress sensing by the endothelial layer. Front. Physiol. 11(July), 1–17 (2020). https://doi.org/10.3389/fphys.2020.00861
Rudolph, A.M., Heymann, M.A., Spitznas, U.: Hemodynamic considerations in the development of narrowing of the aorta. Am. J. Cardiol. 30(5), 514–525 (1972). https://doi.org/10.1016/0002-9149(72)90042-2
Salman, H.E., Yalcin, H.C.: Computational modeling of blood flow hemodynamics for biomechanical investigation of cardiac development and disease. J. Cardiovasc. Dev. Dis. 8(2), 1–27 (2021). https://doi.org/10.3390/JCDD8020014
Schulz, A., et al.: Structured analysis of the impact of fetal motion on phase-contrast MRI flow measurements with metric optimized gating. Sci. Rep. 12(1), 1–11 (2022). https://doi.org/10.1038/s41598-022-09327-1
Struijk, P.C., et al.: Blood pressure estimation in the human fetal descending aorta. Ultrasound Obstet. Gynecol. 32(5), 673–681 (2008). https://doi.org/10.1002/uog.6137
Van Den Wijngaard, J.P., Westerhof, B.E., Faber, D.J., Ramsay, M.M., Westerhof, N., Van Gemert, M.J.: Abnormal arterial flows by a distributed model of the fetal circulation. Am. J. Physiol. Regul. Integr. Comp. Physiol. 291(5), 1222–1233 (2006). https://doi.org/10.1152/ajpregu.00212.2006
Vigneswaran, T.V., Zidere, V., Chivers, S., Charakida, M., Akolekar, R., Simpson, J.M.: Impact of prospective measurement of outflow tracts in prediction of coarctation of the aorta. Ultrasound Obstet. Gynecol. 56(6), 850–856 (2020). https://doi.org/10.1002/uog.21957
Yokoyama, U., Ichikawa, Y., Minamisawa, S., Ishikawa, Y.: Pathology and molecular mechanisms of coarctation of the aorta and its association with the ductus arteriosus. J. Physiol. Sci. 67(2), 259–270 (2016). https://doi.org/10.1007/s12576-016-0512-x
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this paper
Cite this paper
Hermida, U. et al. (2023). Shape-Guided In-Silico Characterization of 3D Fetal Arch Hemodynamics in Suspected Coarctation of the Aorta. In: Bernard, O., Clarysse, P., Duchateau, N., Ohayon, J., Viallon, M. (eds) Functional Imaging and Modeling of the Heart. FIMH 2023. Lecture Notes in Computer Science, vol 13958. Springer, Cham. https://doi.org/10.1007/978-3-031-35302-4_51
Download citation
DOI: https://doi.org/10.1007/978-3-031-35302-4_51
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-35301-7
Online ISBN: 978-3-031-35302-4
eBook Packages: Computer ScienceComputer Science (R0)