The Aortic Isthmus: A Significant yet Underexplored Watershed of the Fetal Circulation.

Abstract:

:The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphragmatic fetal circulations. Several indices have been devised to quantify different components of the waveform, including the pulsatility index, resistance index, isthmic flow index, and recently the isthmic systolic index. There have been promising preliminary studies applying these indices to both cardiac (congenital) and extracardiac pathologies, including intrauterine growth restriction and twin-twin transfusion syndrome. However, the waveform's multifactorial origin has proven to be challenging, and the difficulty in separating various components of the waveform could explain that AoI evaluation does not have a clear clinical utility. Further research is underway to realise the full potential of this vessel in fetal cardiac and haemodynamically compromised pathological conditions. In this review article we outline the physiological origin of this Doppler waveform, describe in detail the various published indices, summarise the published literature to date, and finally outline potential future research and hopefully clinical applications.

journal_name

Fetal Diagn Ther

authors

Tynan D,Alphonse J,Henry A,Welsh AW

doi

10.1159/000446942

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

81-93

issue

2

eissn

1015-3837

issn

1421-9964

pii

000446942

journal_volume

40

pub_type

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