Advertisement

Assessment of Haemodynamic Remodeling in Fetal Aortic Coarctation Using a Lumped Model of the Circulation

  • Paula Giménez MínguezEmail author
  • Bart Bijnens
  • Gabriel Bernardino
  • Èric Lluch
  • Iris Soveral
  • Olga Gómez
  • Patricia Garcia-Canadilla
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 10263)

Abstract

Introduction: Aortic coarctation is one of the most difficult cardiac defects to diagnose before birth, and it accounts for 8% of congenital heart diseases. Antenatal diagnosis is crucial for early treatment of the neonate and to decrease the risk of morbidity and mortality; however the fetal hemodynamic changes are not fully understood and current imaging methods are limited to accurately diagnosis this congenital defect. Objective: We propose to use a lumped model of the fetal circulation to provide insights into the hemodynamic changes in fetuses with aortic coarctation, and thus helping to improve its diagnosis. Methods: To achieve this goal a patient-specific lumped model of the fetal circulation was implemented in OpenCOR, including the modeling of different types and degrees of aortic coarctation. A parametric study of degree and type of coarctation was performed, where blood flow distribution, cerebroplacental ratio, pressure drop over the coarctation and left ventricular pressure were quantified. Results: Obvious changes in the fetal hemodynamics were observed only from 80% of coarctation, corresponding to the clinically used cut-off for pressure drop of 20 mmHg. Furthermore, the observed hemodynamic changes were different depending on the location and degree of the coarctation.

Keywords

Fetal circulation Modeling Aortic coarctation 

Notes

Acknowledgments

This study was partially supported by the Spanish Ministry of Economy and Competitiveness (grant TIN2014-52923-R; Maria de Maeztu Units of Excellence Programme - MDM-2015-0502), FEDER and the European Union Horizon 2020 Programme for Research and Innovation, under grant agreement No. 642676 (CardioFunXion).

References

  1. 1.
    Buyens, A., Gyselaers, W., Coumans, A., Al Nasiry, S., Willekes, C., Boshoff, D., Witters, I., et al.: Difficult prenatal diagnosis: fetal coarctation. FVV ObGyn. 4, 230–236 (2012)Google Scholar
  2. 2.
    Espinoza, J., Romero, R., Kusanovic, J.P., Gotsch, F., et al.: Prenatal diagnosis of coarctation of the aorta with the multiplanar display and B-flow imaging using 4-dimensional sonography. J. Ultrasound Med. 28, 1375–1378 (2009). https://doi.org/10.7863/jum.2009.28.10.1375 CrossRefGoogle Scholar
  3. 3.
    Achiron, R., Zimand, S., Rotstein, Z., et al.: Fetal aortic arch measurements between 14 and 38 weeks’ gestation: in‐utero ultrasonographic study. Ultrasound Obstet. Gynecol. 15, 226–230 (2000). https://doi.org/10.7863/jum.2009.28.10.1375 CrossRefGoogle Scholar
  4. 4.
    Matsui, H., Mellander, M., Roughton, M., et al.: Morphological and physiological predictors of fetal aortic coarctation. Circulation 118, 1793–1801 (2008). https://doi.org/10.1161/CIRCULATIONAHA.108.787598 CrossRefGoogle Scholar
  5. 5.
    Kenny, J.F., Plappert, T., Sutton, M.S.J., et al.: Changes in intracardiac blood flow velocities and right and left ventricular stroke volumes with gestational age in the normal human fetus: a prospective doppler echocardiographic study. Circulation 74, 1208–1216 (1986). https://doi.org/10.1161/01.CIR.74.6.1208 CrossRefGoogle Scholar
  6. 6.
    Mukai, Y., Samura, O., Teraoka, Y., Sasaki, M.: Prenatal diagnosis of coarctation of the aorta using the three-vessel view by calculating the ratio of the diameter of the aortic root to that of the pulmonary artery. Ultrasound Obs. Gynecol. 44, 1793–1801 (2014). https://doi.org/10.1002/uog.14118 Google Scholar
  7. 7.
    Garcia-Canadilla, P., Rudenick, P.A., Crispi, F., Cruz-Lemini, M., Palau, G., Camara, O., et al.: A computational model of the fetal circulation to quantify blood redistribution in intrauterine growth restriction. PLoS Comput. Biol. 10, e1003667 (2014). doi: 10.1371/journal.pcbi.1003667 CrossRefGoogle Scholar
  8. 8.
    Garcia-Canadilla, P., Rudenick, P.A., Crispi, F., Cruz-Lemini, M., Triunfo, S., Nadal, A., et al.: Patient-specific estimates of vascular and placental properties in growth-restricted fetuses based on a model of the fetal circulation. Placenta 36, 981–989 (2015). doi: 10.1016/j.placenta.2015.07.130 CrossRefGoogle Scholar
  9. 9.
    Hunter, P.: OpenCOR Tutorial (2016)Google Scholar
  10. 10.
    Szpinda, M.: Length growth of the various aortic segments in human foetuses. Folia Morphol. 67, 245–250 (2008)Google Scholar
  11. 11.
    Yamamoto, Y., Khoo, N.S., Brooks, P.A., Savard, W., et al.: Severe left heart obstruction with retrograde arch flow influences fetal cerebral and placental blood flow. Ultrasound Obstet. Gynecol. 42, 294–299 (2013). doi: 10.1002/uog.12448 CrossRefGoogle Scholar
  12. 12.
    Beauchesne, L.M., Connolly, H.M., et al.: Coarctation of the aorta: outcome of pregnancy. J. Am. Coll. Cardiol. 38, 1728–1733 (2001). https://doi.org/10.1016/S0735-1097(01)01617-5 CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Paula Giménez Mínguez
    • 1
    Email author
  • Bart Bijnens
    • 1
  • Gabriel Bernardino
    • 1
  • Èric Lluch
    • 2
  • Iris Soveral
    • 3
  • Olga Gómez
    • 3
  • Patricia Garcia-Canadilla
    • 1
  1. 1.Univesitat Pompeu FabraBarcelonaSpain
  2. 2.Philips Research MedisysSuresnesFrance
  3. 3.Fetal i+D Fetal Medical Research CenterBarcelonaSpain

Personalised recommendations