Web of Science: 30 cites, Scopus: 51 cites, Google Scholar: cites,
A Computational Model of the Fetal Circulation to Quantify Blood Redistribution in Intrauterine Growth Restriction
Garcia-Canadilla, Patricia (Universitat Pompeu Fabra)
Rudenick, Paula A. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Crispi, Fatima (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Cruz-Lemini, Monica (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Palau, Georgina (Universitat Pompeu Fabra)
Camara, Oscar (Universitat Pompeu Fabra)
Gratacos, Eduard (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Bijens, Bart H. (Institució Catalana de Recerca i Estudis Avançats)
Universitat Autònoma de Barcelona

Data: 2014
Resum: Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood flow redistribution in order to maintain delivery of oxygenated blood to the brain. Given that, in the fetus the aortic isthmus (AoI) is a key arterial connection between the cerebral and placental circulations, quantifying AoI blood flow has been proposed to assess this brain sparing effect in clinical practice. While numerous clinical studies have studied this parameter, fundamental understanding of its determinant factors and its quantitative relation with other aspects of haemodynamic remodeling has been limited. Computational models of the cardiovascular circulation have been proposed for exactly this purpose since they allow both for studying the contributions from isolated parameters as well as estimating properties that cannot be directly assessed from clinical measurements. Therefore, a computational model of the fetal circulation was developed, including the key elements related to fetal blood redistribution and using measured cardiac outflow profiles to allow personalization. The model was first calibrated using patient-specific Doppler data from a healthy fetus. Next, in order to understand the contributions of the main parameters determining blood redistribution, AoI and middle cerebral artery (MCA) flow changes were studied by variation of cerebral and peripheral-placental resistances. Finally, to study how this affects an individual fetus, the model was fitted to three IUGR cases with different degrees of severity. In conclusion, the proposed computational model provides a good approximation to assess blood flow changes in the fetal circulation. The results support that while MCA flow is mainly determined by a fall in brain resistance, the AoI is influenced by a balance between increased peripheral-placental and decreased cerebral resistances. Personalizing the model allows for quantifying the balance between cerebral and peripheral-placental remodeling, thus providing potentially novel information to aid clinical follow up. Intrauterine growth restriction (IUGR) is one of the leading causes of perinatal mortality and can be defined as a low birth weight together with signs of chronic hypoxia or malnutrition. It is mostly due to placental insufficiency resulting in a chronic restriction of oxygen and nutrients to the fetus. IUGR leads to cardiac dysfunction in utero which can persist postnatally. Under these altered conditions, IUGR fetuses redistribute their blood in order to maintain delivery of oxygenated blood to the brain, known as brain sparing. Given that, in the fetus the aortic isthmus (AoI) is a key arterial connection between the cerebral and placental circulations, quantifying AoI blood flow has been proposed to assess this brain sparing effect in clinical practice. However, which remodeling or redistribution processes in the cardiovascular systems induce the observed changes in AoI flow in IUGR fetuses is not fully understood. We developed a computational model of the fetal circulation, including the key elements related to fetal blood redistribution. Using measured cardiac outflow profiles to allow personalization, we can recreate and better understand the blood flow changes in individual IUGR fetuses.
Ajuts: Ministerio de Ciencia e Innovación PI11/00051
Instituto de Salud Carlos III PI11/01709
Instituto de Salud Carlos III PI12/00801
Ministerio de Ciencia e Innovación SAF2012-37196
Ministerio de Ciencia e Innovación I12/00362
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Llengua: Anglès
Document: Article ; recerca ; Versió publicada
Publicat a: PLoS computational biology, Vol. 10 (june 2014) , ISSN 1553-7358

DOI: 10.1371/journal.pcbi.1003667
PMID: 24921933


14 p, 2.2 MB

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