TY - JOUR
T1 - The onset of coarctation of the aorta before birth
T2 - Mechanistic insights from fetal arch anatomy and haemodynamics
AU - Hermida, Uxio
AU - van Poppel, Milou P.M.
AU - Sabry, Malak
AU - Keramati, Hamed
AU - Steinweg, Johannes K.
AU - Simpson, John M.
AU - Vigneswaran, Trisha V.
AU - Razavi, Reza
AU - Pushparajah, Kuberan
AU - Lloyd, David F.A.
AU - Lamata, Pablo
AU - De Vecchi, Adelaide
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/11
Y1 - 2024/11
N2 - Accurate prenatal diagnosis of coarctation of the aorta (CoA) is challenging due to high false positive rate burden and poorly understood aetiology. Despite associations with abnormal blood flow dynamics, fetal arch anatomy changes and alterations in tissue properties, its underlying mechanisms remain a longstanding subject of debate hindering diagnosis in utero. This study leverages computational fluid dynamics (CFD) simulations and statistical shape modelling to investigate the interplay between fetal arch anatomy and blood flow alterations in CoA. Using cardiac magnetic resonance imaging data from 188 fetuses, including normal controls and suspected CoA cases, a statistical shape model of the fetal arch anatomy was built. From this analysis, digital twin models of false and true positive CoA cases were generated. These models were then used to perform CFD simulations of the three-dimensional fetal arch haemodynamics, considering physiological variations in arch shape and blood flow conditions across the disease spectrum. This analysis revealed that independent changes in the shape of. the arch and the balance of left-to-right ventricular output led to qualitatively similar haemodynamic alterations. Transitioning from a false to a true positive phenotype increased retrograde flow through the aortic isthmus. This resulted in the appearance of an area of low wall shear stress surrounded by high wall shear stress values at the flow split apex on the aortic posterior wall opposite the ductal insertion point. Our results suggest a distinctive haemodynamic signature in CoA characterised by the appearance of retrograde flow through the aortic isthmus and altered wall shear stress at its posterior side. The consistent link between alterations in shape and blood flow in CoA suggests the need for comprehensive anatomical and functional diagnostic approaches in CoA. This study presents an application of the digital twin approach to support the understanding of CoA mechanisms in utero and its potential for improved diagnosis before birth.
AB - Accurate prenatal diagnosis of coarctation of the aorta (CoA) is challenging due to high false positive rate burden and poorly understood aetiology. Despite associations with abnormal blood flow dynamics, fetal arch anatomy changes and alterations in tissue properties, its underlying mechanisms remain a longstanding subject of debate hindering diagnosis in utero. This study leverages computational fluid dynamics (CFD) simulations and statistical shape modelling to investigate the interplay between fetal arch anatomy and blood flow alterations in CoA. Using cardiac magnetic resonance imaging data from 188 fetuses, including normal controls and suspected CoA cases, a statistical shape model of the fetal arch anatomy was built. From this analysis, digital twin models of false and true positive CoA cases were generated. These models were then used to perform CFD simulations of the three-dimensional fetal arch haemodynamics, considering physiological variations in arch shape and blood flow conditions across the disease spectrum. This analysis revealed that independent changes in the shape of. the arch and the balance of left-to-right ventricular output led to qualitatively similar haemodynamic alterations. Transitioning from a false to a true positive phenotype increased retrograde flow through the aortic isthmus. This resulted in the appearance of an area of low wall shear stress surrounded by high wall shear stress values at the flow split apex on the aortic posterior wall opposite the ductal insertion point. Our results suggest a distinctive haemodynamic signature in CoA characterised by the appearance of retrograde flow through the aortic isthmus and altered wall shear stress at its posterior side. The consistent link between alterations in shape and blood flow in CoA suggests the need for comprehensive anatomical and functional diagnostic approaches in CoA. This study presents an application of the digital twin approach to support the understanding of CoA mechanisms in utero and its potential for improved diagnosis before birth.
KW - Computational fluid dynamics
KW - Digital twin
KW - Fetal magnetic resonance imaging
KW - Statistical shape model
KW - Wall shear stress
UR - http://www.scopus.com/inward/record.url?scp=85203514955&partnerID=8YFLogxK
U2 - 10.1016/j.compbiomed.2024.109077
DO - 10.1016/j.compbiomed.2024.109077
M3 - Article
C2 - 39265477
AN - SCOPUS:85203514955
SN - 0010-4825
VL - 182
JO - Computers in Biology and Medicine
JF - Computers in Biology and Medicine
M1 - 109077
ER -