Shape-Guided In-Silico Characterization of 3D Fetal Arch Hemodynamics in Suspected Coarctation of the Aorta

Abstract

Coarctation of the aorta (CoA) is a prevalent congenital heart defect. Its prenatal diagnosis is challenging, with high false positive rates. The exact cause of CoA is yet not fully understood. Recent research has provided novel insights into the anatomical determinants of CoA based on the in-utero arch anatomy. However, it is also recognized that the pathophysiology of CoA is also intrinsically linked to abnormal flow dynamics. To investigate the interplay between arch anatomy and flow, Computational Fluid Dynamics (CFD) analysis was performed in two fetal cases - a true and a false positive CoA. These anatomies were selected from a population of 108 fetuses with suspected CoA based on a statistical shape analysis score and clinical outcomes. A simplified 0D model of the fetal circulation informed by 2D PC-MRI was used to find patient-specific boundary conditions for an open-loop 3D-0D CFD model. Results from the 3D CFD models were validated against clinical imaging data for each case and provided initial evidence of hemodynamic differences between false positive and true positive CoA cases. These findings demonstrate the potential of using the SSM-guided CFD analysis on a larger cohort of representative cases to better understand the disease mechanisms in CoA and improve its diagnosis before birth.