{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T21:02:56Z","timestamp":1763499776300,"version":"3.40.5"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Aortic wall stiffness has been reported in infants with tetralogy of Fallot (ToF) and may contribute to long\u2010term aortic dilation even after corrective repair surgery. However, little is known about aortic elasticity in fetuses with ToF and the association with neonatal aortic dilation. The objectives of this study were to assess measures of elasticity of the ascending aorta (AAo) in fetuses with ToF and explore the association with neonatal aortic annular dilation in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventy\u2010six singleton fetuses with ToF and 76 control fetuses of singleton low\u2010risk pregnancies were enroled into this prospective study. Fetal measures of AAo elasticity, including mean longitudinal strain (MLS), global circumferential strain (GCS) and fractional area change (FAC), were assessed by velocity vector imaging. The <jats:italic>z<\/jats:italic>\u2010score of the aortic valve (AV) diameter at the level of the annulus, as a measure of aortic annular dilation, was determined in newborns. Logistic regression analysis was used to investigate the association between fetal measures of AAo elasticity and neonatal aortic annular dilation (defined as an AV annular <jats:italic>z<\/jats:italic>\u2010score &gt;\u20092) in cases with ToF identified prenatally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median MLS, GCS and FAC in fetuses with ToF were lower than those in normal fetuses (7.52%\u00a0<jats:italic>vs<\/jats:italic> 12.15% for MLS, 22.05% <jats:italic>vs<\/jats:italic> 29.73% for GCS and 34.2% <jats:italic>vs<\/jats:italic> 48.3% for FAC, all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Aortic annular dilation was present in 53\/76 (69.7%) newborns with ToF. After adjustment for gestational age at fetal echocardiography and birth weight, fetal MLS, GCS and FAC were independently associated with aortic annular dilation neonatally, with odds ratios of 0.66, 0.78 and 0.82, respectively (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). The best cut\u2010off values of these prenatal measures of AAo elasticity for predicting neonatal aortic annular dilation in fetuses with ToF were 9.02% for MLS, 23.56% for GCS and 37.2% for FAC (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), with areas under the receiver\u2010operating\u2010characteristics curves of 0.94, 0.91 and 0.93, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Measures of AAo elasticity are decreased in fetuses with ToF. Impaired AAo elasticity in the fetal period is associated with aortic annular dilation postnatally. Additional research is needed to evaluate the relationship between the AAo elasticity injury pattern and degeneration of AAo elasticity under stress as well as the long\u2010term outcome in this population. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26079","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T15:08:43Z","timestamp":1664464123000},"page":"497-503","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot"],"prefix":"10.1002","volume":"61","author":[{"given":"R.","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Ultrasound Diagnosis The Second Xiangya Hospital of Central South University  Changsha Hunan China"},{"name":"Department of Urology The Second Xiangya Hospital of Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Diagnosis The Second Xiangya Hospital of Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Diagnosis The Second Xiangya Hospital of Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Q.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Diagnosis The Second Xiangya Hospital of Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The Second Xiangya Hospital of Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-3481","authenticated-orcid":false,"given":"S.","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Diagnosis The Second Xiangya Hospital of Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14574-6"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.011943"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.118.007611"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-021-01119-3"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezr032"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2011.05.024"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.537928"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2009.08.024"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-016-1478-4"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.12.013"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.840494"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90298-4"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2017.08.011"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.06.011"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.113.301312"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-020-02466-0"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.08.081"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.05.095"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.06.1310"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.3171\/2019.4.FOCUS19225"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.129585"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.09.141"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.05.008"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03152-y"}],"container-title":["Ultrasound in Obstetrics &amp; 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