Key result
Fetal aortic coarctation is linked to higher isthmus wall shear stress, tracking with Z-score deficit.
Why the study?
Prenatal diagnosis of aortic coarctation has a high false-positive rate and biomechanical assessment in fetuses is limited, motivating evaluation of segmental peak systolic wall shear stress in the fetal aortic arch and isthmus and its relationships with anatomical and hemodynamic parameters.
Does vector flow mapping identify alterations in aortic arch and isthmus peak systolic wall shear stress in fetuses with coarctation of the aorta compared to normal controls?
Case-Control (n=116)
Does vector flow mapping identify alterations in aortic arch and isthmus peak systolic wall shear stress in fetuses with coarctation of the aorta compared to normal controls?
Vector flow mapping demonstrates that fetal coarctation of the aorta is characterized by significantly elevated isthmus peak systolic wall shear stress, which independently correlates with isthmus hypoplasia and flow velocity.
Answers are grounded in this paper and cite their sources.
May support vector flow mapping for fetal coarctation evaluation; leaves open prospective validation before clinical adoption.
Objective To evaluate segmental peak systolic wall shear stress (WSS max ) in the aortic arch and isthmus of fetuses with coarctation of the aorta (CoA) and to explore its relationships with conventional anatomical and hemodynamic parameters. Methods This prospective study included 58 CoA fetuses and 58 gestational age‐matched normal controls. Vector flow mapping measured WSS max at the inner and outer curvatures of the aortic arch and isthmus. Within the CoA group, Spearman correlation was used to assess relationships between isthmus WSS max and the isthmus Z‐score, PA/AO, TV/MV, isthmus V max , and RV/LV. Multivariable linear regression was performed using the isthmus Z‐deficit (‐Z), PA/AO, and isthmus V max . Results Arch WSS max did not differ between groups (all p > 0.05). Isthmus WSS max (general, inner, and outer curvature) was significantly higher in the CoA group than in controls (all p < 0.05). Within the CoA group, isthmus WSS max was lower than arch WSS max (all p < 0.05). Isthmus WSS max was correlated with the isthmus Z‐score, PA/AO, and isthmus V max . In multivariable regression, isthmus Z‐deficit ( B = 0.271, 95% CI 0.031–0.510, p < 0.05) and isthmus V max ( B = 0.01, 95% CI 0.001–0.020, p < 0.05) were independently associated with isthmus WSS max , whereas PA/AO was not significant ( p > 0.05). Conclusion Isthmus WSS max is elevated in fetuses with CoA and is independently associated with greater isthmus hypoplasia and higher isthmus flow velocity, suggesting a role in CoA pathophysiology. Its incremental diagnostic value could not be assessed because the control group consisted of normal fetuses. What Is Already Known About this Topic? Prenatal diagnosis of aortic coarctation (CoA) has a high false‑positive rate. Hemodynamic changes in CoA include increased velocity and turbulence, but biomechanical assessment in fetuses is limited. What Does this Study Add? This study uses VFM to quantify WSS max in the fetal aortic arch and isthmus. Isthmus WSS max is significantly elevated in fetuses with CoA and is independently associated with greater isthmus hypoplasia and higher isthmus flow velocity, providing mechanistic insights into the biomechanical alterations of fetal CoA.
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Xu et al. (2026) conducted a case-control in Fetal coarctation of the aorta (CoA) (n=116). Fetal coarctation of the aorta (CoA) assessed via vector flow mapping vs. Gestational age-matched normal control fetuses was evaluated on Segmental peak systolic wall shear stress (WSS max) in the aortic arch and isthmus (B = 0.271 (isthmus Z-deficit), 95% CI 0.031-0.510, p=<0.05). Fetal coarctation of the aorta had significantly higher isthmus peak systolic wall shear stress than controls (p<0.05), independently associated with isthmus Z-deficit (B=0.271, 95% CI 0.031-0.510).
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