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

Mínguez, Paula Giménez; Bijnens, Bart; Bernardino, Gabriel; Lluch, Èric; Soveral, I.; Gómez, O.; García-Cañadilla, Patricia

doi:10.1007/978-3-319-59448-4_45

Cited by 2 publications

(1 citation statement)

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“…This is in agreement with other studies that reported that bidirectional isthmic flow or isthmic flow reversal has a low sensitivity and specificity in detecting CoA prenatally (13,(34)(35)(36). Furthermore, not only the degree but also the site of the isthmic narrowing may play a role in the occurrence of fetal systolic isthmic flow reversal (37). Furthermore, the definitive narrowing in the aortic isthmus may only occur in the neonatal period when the arterial duct closes (22).…”

Section: Discrimination Between True Coa and False Positives With Hel...supporting

confidence: 92%

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

Fricke,

Ryd,

Weismann

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSevere left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging.ObjectivesTo compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis.MethodsProspective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022.ResultsA total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA.ConclusionFetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow.

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Section: Discrimination Between True Coa and False Positives With Hel...supporting

confidence: 92%

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

Fricke,

Ryd,

Weismann

et al. 2023

Front. Cardiovasc. Med.

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Machine Learning in Fetal Cardiology: What to Expect

et al. 2020

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In fetal cardiology, imaging (especially echocardiography) has demonstrated to help in the diagnosis and monitoring of fetuses with a compromised cardiovascular system potentially associated with several fetal conditions. Different ultrasound approaches are currently used to evaluate fetal cardiac structure and function, including conventional 2-D imaging and M-mode and tissue Doppler imaging among others. However, assessment of the fetal heart is still challenging mainly due to involuntary movements of the fetus, the small size of the heart, and the lack of expertise in fetal echocardiography of some sonographers. Therefore, the use of new technologies to improve the primary acquired images, to help extract measurements, or to aid in the diagnosis of cardiac abnormalities is of great importance for optimal assessment of the fetal heart. Machine leaning (ML) is a computer science discipline focused on teaching a computer to perform tasks with specific goals without explicitly programming the rules on how to perform this task. In this re-view we provide a brief overview on the potential of ML techniques to improve the evaluation of fetal cardiac function by optimizing image acquisition and quantification/segmentation, as well as aid in improving the prenatal diagnoses of fetal cardiac remodeling and abnormalities.

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

Cited by 2 publications

References 10 publications

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

Machine Learning in Fetal Cardiology: What to Expect

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