Developmental Changes in Aortic Mechanical Properties in Normal Fetuses and Fetuses with Cardiovascular Disease

Abstract

We hypothesized that fetal aortic mechanical properties assessed by aortic diameter (AoD) and flow show maturational changes during the gestational period, and that these properties are different in fetuses with congenital heart diseases and fetuses with normal development. Phasic changes in ascending AoD along with Doppler flow profile were measured in 84 consecutive normal fetuses (gestational age, 18-36weeks) and in 30 consecutive fetuses with cardiovascular diseases (gestational age, 22-39weeks). AoD and cardiac output significantly increased with gestational age. Fetal aortic compliance (AC), assessed as (maximum AoD - minimum AoD)/stroke volume, significantly decreased with gestational age in normal fetuses, indicating maturational changes in aortic wall properties. Importantly, fetuses with Marfan syndrome and tetralogy of Fallot that exhibit "aortopathy" showed significantly lower AC than normal fetuses of the same gestational age, suggesting intrinsic abnormalities in aortic wall properties in these diseases. Fetuses with trisomy 18 and Noonan syndrome also had AC values below the normal ranges. Measurements of phasic changes in fetal AoD and flow measurements can provide useful information about aortic mechanical properties and may help clarify abnormal arterial hemodynamics in pathologic conditions.