Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

Xu, Ran; Zhou, Dan; Liu, M; Zhou, Qing; Xie, Li; Zeng, Shi

doi:10.1002/uog.26079

Cited by 4 publications

(4 citation statements)

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“…Increased preload volume through the aorta and abnormal aortic geometry caused by a misaligned dextrorotated aortic root are likely to have contributed to aortic hemodynamic disturbance in ToF. Our previous research demonstrated impaired aortic elastic properties in fetuses with ToF 22 . We believe that aortic flow perturbation is associated with an increased risk for late aortic complications in fetuses with ToF, but further research is needed to identify this association.…”

Section: Discussionmentioning

confidence: 92%

Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle‐tracking echocardiography

Hou

Zhou

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveBlood‐flow pattern is an essential factor for cardiovascular development. Recently, blood speckle tracking (BST) echocardiography based on high‐frame‐rate ultrasound has become a promising technique for the assessment of blood flow patterns and properties. However, the clinical applications in fetuses with congenital heart defects (CHDs) are unclear. The objective of this study was to observe the feasibility and blood flow patterns of fetuses with CHD by BST.MethodsThirty‐five normal fetuses, 35 fetuses with left‐sided obstructive lesions (LSOLs) and 35 fetuses with right‐sided obstructive lesions (RSOLs) were enrolled in this prospective cross‐sectional study. BST images of fetal intracardiac regions of interest (ROIs), including the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), aortic arch (AA), descending aorta (DAo) and main pulmonary artery (PA), were obtained and analyzed. The feasibility, blood flow pattern and number of vortices in the ROIs were recorded.ResultsThe median GA was 24.7 weeks (range, 19.6–34.3 weeks). The overall feasibility of the BST image was 81.6%, and the cutoff value of depth for an adequate BST image was ≤7.9 cm. There were no differences in the presence of vortex/turbulent blood flow in either the LV or RV among the three groups. Vortex/turbulent blood flow was detected in 14.3% (5/35) and 57.1% (20/35) of AAos, 14.3% (5/35) and 57.1% (18/35) of AAs, 48.6% (17/35) and 0 (0/35) DAos, and 40% (14/35) and 51.4% (18/35) of PAs in the LSOL and RSOL groups, respectively, all of which were significantly higher than the rates in normal fetuses (P<0.01). The numbers of vortices in the LV, AAo, AA, DAo and PA regions were significantly higher in fetuses with CHD than in normal control fetuses (P<0.01).ConclusionsFetuses with CHD exhibited more prevalent vortex/turbulent blood flow and/or elevated vortices in the great arteries. Further study is needed to determine the biomechanical effect of blood flow patterns, especially vortex flow, on fetal cardiovascular structure and function.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 92%

Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle‐tracking echocardiography

Hou

Zhou

et al. 2023

Ultrasound in Obstet & Gyne

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“…I read with great interest the paper by Xu et al 1 . about the altered elasticity of the proximal portion of the aorta in fetuses affected by tetralogy of Fallot (ToF).…”

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confidence: 99%

“…about the altered elasticity of the proximal portion of the aorta in fetuses affected by tetralogy of Fallot (ToF). This is a well known phenomenon, but these authors have, for the first time, shown that impaired elasticity starts in fetal life 1 . Previous histological studies in cases of ToF revealed a non‐inflammatory loss of smooth muscle cells, mucoid degeneration and fragmentation of the elastic fibers within the tunica media, implying a lack of preservation of the elastic properties of the arterial wall 2 .…”

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Re: Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

Bassareo

2023

Ultrasound in Obstet & Gyne

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Impaired Distensibility of the Proximal Aorta in Fetuses With Tetralogy of Fallot

Zhou

et al. 2023

JAHA

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Background Increased aortic wall stiffness, which even persists after repair, has been reported in patients with tetralogy of Fallot (TOF). We aimed to observe the distensibility of the ascending aorta and descending aorta in fetuses with TOF and explore its relation with aortic blood flow volume and aortic and pulmonary annular size. Methods and Results Twenty‐three fetuses with TOF and 23 gestational age–matched normal fetuses were included in this prospective cross‐sectional study. The distensibilities of the ascending aorta and descending aorta were assessed by aortic strain (AS), which was defined as follows: 100×(maximum internal diameter in the systolic phase–minimum internal diameter in the diastolic phase)/minimum internal diameter in the diastolic phase. The maximum internal diameter in the systolic phase and minimum internal diameter in the diastolic phase of the ascending aorta and descending aorta were measured by M‐mode echocardiography. Associations between AS and aortic blood flow volume and aortic and pulmonary valve diameters were assessed in both groups. AS of the ascending aorta in TOF group was lower than that in controls (20.48%±4.19% versus 28.17%±4.54%; P <0.001), whereas there was no significant difference in the descending aorta. The multivariate regression model demonstrated that AS was significantly related to aortic valve size ( P =0.014) and aortic blood flow volume ( P =0.022) in fetuses with TOF, whereas only aortic blood flow volume was significantly correlated with AS in the control group ( P =0.01). No significant association was found between AS and pulmonary valve size. Conclusions Impaired distensibility of proximal aorta was observed in fetuses with TOF. Both intrinsic abnormalities of the aortic wall and aortic volume overload probably play roles in the altered aortic distensibility.

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Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

Cited by 4 publications

References 24 publications

Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle‐tracking echocardiography

Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle‐tracking echocardiography

Re: Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

Impaired Distensibility of the Proximal Aorta in Fetuses With Tetralogy of Fallot

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