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Analysis of three-dimensional arch anatomy, vascular flow and postnatal outcome in cases of suspected coarctation of the aorta using fetal cardiac MRI

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
JournalCirculation-Cardiovascular imaging
Accepted/In press14 Apr 2021

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Abstract

Background: Identifying fetuses at risk of severe neonatal coarctation of the aorta (CoA) can be lifesaving, but is notoriously challenging in clinical practice with a high rate of false positives. Novel fetal 3D and phase-contrast MRI techniques offer an unprecedented means of assessing the human fetal cardiovascular system before birth. We performed detailed MRI assessment of fetal vascular morphology and flows in a cohort of fetuses with suspected CoA, correlated with the need for postnatal intervention.
Methods: Women carrying a fetus with suspected CoA on echocardiography were referred for MRI assessment between 26-36 weeks gestation, including high-resolution motion-corrected 3D volumes of the fetal heart and phase-contrast flow sequences gated with metric optimized gating. The relationship between aortic geometry and vascular flows was then analyzed and compared to postnatal outcome.
Results: 72 patients (51 with suspected fetal CoA and 21 healthy controls) underwent fetal MRI with motion-corrected 3D vascular reconstructions. Vascular flow measurements from phase contrast sequences were available in 53 patients. In the CoA group, 25/51 (49%) required surgical repair of coarctation after birth; the remaining 26/51 (51%) were discharged without neonatal intervention. Reduced blood flow in the fetal ascending aorta and at the aortic isthmus were associated with increasing angulation (p = 0.005) and proximal displacement (p = 0.006) and was seen in both true positive and false positive cases. A multivariate logistic regression model including aortic flow and isthmal displacement explained 78% of the variation in outcome and correctly predicted the need for intervention 93% of cases.
Conclusions: Reduced blood flow though the left heart is associated with important configurational changes at the aortic isthmus in fetal life, predisposing to CoA when the arterial duct closes after birth. Novel fetal MRI techniques may have a role in both understanding and accurately predicting severe neonatal CoA.

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