Aortic Elasticity and Cardiac Function in Fetuses With Aortic Coarctation

Abstract

ObjectiveThe purpose of the study was to observe the elasticity of the ascending aorta (AAo) in normal fetuses and fetuses with coarctation of the aorta (CoA) by M-mode echocardiography.MethodsThis was a prospective clinical study performed on 16 fetuses with CoA and 48 gestational-age matched normal fetuses. The minimum internal diameter in the diastolic phase (Dmin) and the maximum internal diameter in the systolic phase (Dmax) of the AAo were measured by M-mode echocardiography. The aortic strain was calculated using the formula 100 × (Dmax−Dmin)/Dmin). Doppler echocardiography was performed to measure the cardiac function parameters. Correlations between aortic strain and cardiac function were assessed in fetuses with CoA.ResultsThe aortic strain of the ascending aorta in the fetuses with CoA was significantly lower than that in normal fetuses (18.12 ± 4.88% vs. 25.22 ± 4.92%, p < 0.01). The fetuses with CoA showed significantly higher combined cardiac output than the controls (471.89 ± 93.98 vs. 411.57 ± 46.35 ml/min/kg, p < 0.05). Compared with the normal group, the early diastolic velocities (E') and peak systolic velocities (S') of the left side were obviously decreased in the CoA group (p < 0.05), while the left early diastolic velocity ratio (E/E') was significantly increased in the fetuses with CoA (p < 0.01). For the fetuses with CoA, the aortic strain of the AAo was correlated with the left E/E' and S' (r = −0.522 and 0.504, respectively, P < 0.05).ConclusionsThe aortic strain of the ascending aorta was significantly decreased in fetuses with CoA in middle-late gestation. The impaired strain of the ascending aorta was correlated with the left ventricle function in the fetuses with CoA. These findings imply that the abnormalities of the intrinsic aortic wall of CoA might develop early in utero.

Impaired Elastic Properties of the Ascending Aorta in Fetuses With Coarctation of the Aorta

“…Altered ventricular–arterial coupling has been described in patients with repaired CoA and is thought to promote hypertension. 20 Recently, our team 21 demonstrated the association of decreased ascending aortic diameter strain with impaired left E' and S′ in the fetuses with CoA and first reported ventricular–arterial interactions in fetuses with CoA. Vessel distensibility is influenced by not only vessel elasticity but also cardiac contractility and cardiac output.…”