Fluid mechanical effects of fetal aortic valvuloplasty for cases of critical aortic stenosis with evolving hypoplastic left heart syndrome
Author(s)
Wong, Hong Shen
Li, Binghuan
Tulzer, Andreas
Tulzer, Gerald
Yap, Choon Hwai
Type
Journal Article
Abstract
Fetuses with critical aortic stenosis (FAS) are at high risk of progression to HLHS by the time of birth (and are thus termed “evolving HLHS”). An in-utero catheter-based intervention, fetal aortic valvuloplasty (FAV), has shown promise as an intervention strategy to circumvent the progression, but its impact on the heart’s biomechanics is not well understood. We performed patient-specific computational fluid dynamic (CFD) simulations based on 4D fetal echocardiography to assess the changes in the fluid mechanical environment in the FAS left ventricle (LV) directly before and 2 days after FAV. Echocardiograms of five FAS cases with technically successful FAV were retrospectively analysed. FAS compromised LV stroke volume and ejection fraction, but FAV rescued it significantly. Calculations to match simulations to clinical measurements showed that FAV approximately doubled aortic valve orifice area, but it remained much smaller than in healthy hearts. Diseased LVs had mildly stenotic mitral valves, which generated fast and narrow diastolic mitral inflow jet and vortex rings that remained unresolved directly after FAV. FAV further caused aortic valve damage and high-velocity regurgitation. The high-velocity aortic regurgitation jet and vortex ring caused a chaotic flow field upon impinging the apex, which drastically exacerbated the already high energy losses and poor flow energy efficiency of FAS LVs. Two days after the procedure, FAV did not alter wall shear stress (WSS) spatial patterns of diseased LV but elevated WSS magnitudes, and the poor blood turnover in pre-FAV LVs did not significantly improve directly after FAV. FAV improved FAS LV’s flow function, but it also led to highly chaotic flow patterns and excessively high energy losses due to the introduction of aortic regurgitation directly after the intervention. Further studies analysing the effects several weeks after FAV are needed to understand the effects of such biomechanics on morphological development.
Date Issued
2023-07-01
Date Acceptance
2023-01-16
Citation
Annals of Biomedical Engineering, 2023, 51 (7), pp.1485-1498
ISSN
0090-6964
Publisher
Springer Science and Business Media LLC
Start Page
1485
End Page
1498
Journal / Book Title
Annals of Biomedical Engineering
Volume
51
Issue
7
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36780051
PII: 10.1007/s10439-023-03152-x
Subjects
Fetal aortic stenosis and evolving hypoplastic left heart syndrome
Fetal cardiac intervention
Fetal cardiology
Fluid mechanics
Humans
Hypoplastic Left Heart Syndrome
Retrospective Studies
Aortic Valve Insufficiency
Aortic Valve Stenosis
Fetus
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2023-02-13