Congenital heart disease (CHD) is the most common birth defect and a leading cause of death and chronic
illness in newborns, infants, and children. Prenatal screening and identification of CHD are critically important
for the management and treatment of CHD, but its availability and accuracy are confined by the limited
resolutions of current fetal imaging techniques. Personalized flow modeling has been widely used to augment
medical imaging modalities for adult and pediatric heart diseases. However, to date, no validated models have
been developed for fetal circulation.
This project will focus on coarctation of the aorta (CoA), a common CHD accounting for 6-8% of live births
with CHD. CoA occurs when a portion of the aorta is narrowed, usually at the isthmus, and blood flow through it
is obstructed. Both false positive and false negative diagnoses frequently occur in contemporary prenatal
screening and identification of CoA. If the CoA is significant and is not diagnosed and treated in a timely fashion,
the newborn or young infant may develop cardiogenic shock or may die. There is an emerging need for a novel
technique that provides new metrics and knowledge of the fetal aorta. The proposed work aims to
(1) develop a novel, personalized flow modeling paradigm based on routinely used fetal echocardiography
that assesses high-fidelity hemodynamics of the fetal aorta.
(2) validate this novel paradigm in comparison with cutting-edge fetal magnetic resonance imaging
techniques, including both phase-contrast and 4D flow sequences.
(3) use this paradigm to conduct pilot studies identifying novel hemodynamic metrics that discriminate normal
aorta and CoA in fetuses. This project will focus on wall shear stress, which was linked to vessel dilation and
remodeling in general and recurrent coarctation in pediatric and adult patients with repaired CoA but has scarcely
been discussed in the fetal aorta with CoA.
The proposed work will address the challenges and gaps in the research of fetal circulation and fetal heart
disease by producing a novel, validated cardiovascular flow modeling paradigm for personalized hemodynamics
in the fetal aorta. This project represents the first-of-its-kind endeavor to develop a rigorously validated
personalized flow model for fetal circulation. Our long-term goal is to develop paradigm-shifting computational
models for fetal circulation that can be used to uncover the pathogenesis of all critical CHDs to improve
diagnosis/prognosis and to aid in the personalized treatment/prevention of CoA and other critical CHDs.
Additionally, this project will yield new data and knowledge on fetal aortic hemodynamics, which may enable
a better understanding of etiology and improved diagnosis and prognosis of CoA. The tools and knowledge
generated by this project will lay a solid foundation for future translational studies that could lead to improved
screening, diagnosis, and outcomes for children with CoA.
