[R01] Prenatal Diagnosis of Coarctation of the Aorta using CMR
Ente: National Heart Lung and Blood Institute
Scadenza: 2031-02-28
Importo max: 624.789 EUR
Paese: US
Descrizione
PROJECT SUMMARY
Coarctation of the aorta (CoA), a severe congenital narrowing of the aorta, is one of the most common forms of
congenital heart defects with a reported prevalence of approximately 4 per 10,000 live births. It is the second
most costly form of congenital heart disease with pediatric costs in excess of $300M annually, the majority of
which incur shortly after birth. After birth, catastrophic deficits to blood flow can occur and post-natal surgical
correction is required to restore normal blood flow to the brain and body. The current method of prenatal
diagnosis relies on fetal echocardiography. Fetal echocardiography is hampered by many difficulties visualizing
the fetal aortic arch during later gestations, and as a result, and to avoid a missed diagnosis, there is a high
false positive rate of fetal echocardiography for CoA, approaching 50%. The consequence of a prenatal
diagnosis of CoA is intensive third trimester and perinatal care, change in delivery location, and immediate
transfer of the newborn to the CICU to initiate mitigating measures. Additional undesirable outcomes include
an average cost of $84,725 per false positive diagnosis, deleterious emotional effects on materno-fetal
bonding, and socioeconomic effects from the high intensity care required in the last trimester of pregnancy and
after birth.
Fetal cardiac MRI (fetal CMR), with MRI compatible doppler ultrasound gating, has the potential to transform
prenatal diagnosis of CoA, through its superior ability to visualize the aortic arch, and ability to quantify the flow
volumes in the fetal vessels, which can help accurately diagnose CoA, even those who have milder forms of
disease. Despite this great potential, in up to 30% of cases, fetal motion limits our ability to reliably synchronize
the MRI sequence acquisition with fetal heart motion and can result in reconstruction artifacts. With no room for
error in prenatal diagnosis, our proposal builds upon our already effective fetal CMR techniques integrating
methods to address fetal motion. These methods include incorporating a novel acoustic lens into an MRI
compatible doppler ultrasound device enabling the continuous gating of the fetal heartbeat even while the fetus
is moving. This, coupled with our proposed novel motion correction techniques that either reject motion
degraded data or compensate for it, can likely overcome the residual challenges that fetal motion brings to fetal
CMR. Once fetal motion is mitigated, we hypothesize that applying these motion mitigated techniques to
healthy normal volunteers (to create a repository of high-quality normative data) and to fetuses suspected of
having CoA, will improve the accuracy of prenatal diagnosis. The 3D morphology and 4D flow MRI techniques
described in this proposal are readily translatable and the workflow described in our proposal brings this
imaging innovation to the clinical interface, providing a platform for accurate prenatal diagnosis of congenital
heart d
Istituzione: UNIVERSITY OF COLORADO DENVER
PI: ALEXANDER J. BARKER, Lorna Browne
Progetto: 1R01HL178618-01A1
Settori: National Heart Lung and Blood Institute
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