A computational model of the fetal circulation to quantify blood redistribution in intrauterine growth restriction

García Cañadilla, Patricia, 1985-; Rudenick, Paula A.; Crispi Brillas, Fàtima; Cruz-Lemini, Mónica; Palau, Georgina; Camara, Oscar; Gratacós Solsona, Eduard; Bijnens, Bart

A computational model of the fetal circulation to quantify blood redistribution in intrauterine growth restriction

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Garcia-Canadilla P, Rudenick PA, Crispi F, Cruz-Lemini M, Palau G, Camara O, Gratacos E, Bijens BH. A computational model of the fetal circulation to quantify blood redistribution in intrauterine growth restriction. PLoS Computational Biology. 2014;10(6):1-14. DOI: 10.1371/journal.pcbi.1003667.

Abstract

Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood flow redistribution in order to/nmaintain delivery of oxygenated blood to the brain. Given that, in the fetus the aortic isthmus (AoI) is a key arterial/nconnection between the cerebral and placental circulations, quantifying AoI blood flow has been proposed to assess this/nbrain sparing effect in clinical practice. While numerous clinical studies have studied this parameter, fundamental/nunderstanding of its determinant factors and its quantitative relation with other aspects of haemodynamic remodeling has/nbeen limited. Computational models of the cardiovascular circulation have been proposed for exactly this purpose since/nthey allow both for studying the contributions from isolated parameters as well as estimating properties that cannot be/ndirectly assessed from clinical measurements. Therefore, a computational model of the fetal circulation was developed,/nincluding the key elements related to fetal blood redistribution and using measured cardiac outflow profiles to allow/npersonalization. The model was first calibrated using patient-specific Doppler data from a healthy fetus. Next, in order to/nunderstand the contributions of the main parameters determining blood redistribution, AoI and middle cerebral artery/n(MCA) flow changes were studied by variation of cerebral and peripheral-placental resistances. Finally, to study how this/naffects an individual fetus, the model was fitted to three IUGR cases with different degrees of severity. In conclusion, the/nproposed computational model provides a good approximation to assess blood flow changes in the fetal circulation. The/nresults support that while MCA flow is mainly determined by a fall in brain resistance, the AoI is influenced by a balance/nbetween increased peripheral-placental and decreased cerebral resistances. Personalizing the model allows for quantifying/nthe balance between cerebral and peripheral-placental remodeling, thus providing potentially novel information to aid/nclinical follow up.