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Prenatally, it has mild hemodynamic effects as right ventricular disproportion and ductus arteriosus (DA) dilation occur as adaptive mechanisms, but their impact on CoA hemodynamics remains poorly understood. To investigate this, we built a closed 0D computational model of fetal circulation and simulated different CoA cardiovascular remodeling patterns, including aortic isthmus (AoI) narrowing, ventricular disproportion, and DA dilation. Our results showed mild AoI narrowing (80% of reference diameter) required up to 1.7 right\/left ventricular end-diastolic volume ratio and 115% DA dilation to maintain physiological pressures, wall shear stresses, and organ perfusion. In contrast, severe narrowing (20% of reference AoI diameter) required up to 5 right\/left ventricular end-diastolic volume ratio and 125% DA dilation, highlighting the necessity of co-occurrence of prenatal ventricular disproportion and DA dilation to compensate for AoI narrowing. These physiological regions were validated with ultrasonographic measurements from 7 controls and 9 CoA patients. We compared blood pressures, velocities, and volumetric flow rates across different fetoplacental anatomical sites. AoI velocity showed a delayed retrograde flow peak and increased antegrade diastolic velocity with greater AoI narrowing, which may aid in diagnosing CoA. Minimal differences were observed in other velocities and pressures. Volumetric flow rates across varying degrees of AoI narrowing decreased in the AoI and mitral and aortic valves, remained stable in the middle cerebral and umbilical arteries, and increased in the DA and tricuspid and pulmonary valves. Therefore, we corroborated that in fetal CoA a redistribution of blood flow occurs to ensure perfusion of the brain and placenta, without a significant alteration in fetal hemodynamics (blood pressure and velocities) except for increased diastolic velocities in the AoI.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1013096","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T20:02:48Z","timestamp":1748635368000},"page":"e1013096","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Understanding the hemodynamic changes in fetuses with coarctation of the aorta using a lumped model of fetal 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The meaning of Murray\u2019s law","volume":"78","author":"TF Sherman","year":"1981","journal-title":"J Gen Physiol"},{"issue":"6","key":"pcbi.1013096.ref033","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1002\/uog.21970","article-title":"Early cardiac remodeling in aortic coarctation: insights from fetal and neonatal functional and structural assessment","volume":"56","author":"I Soveral","year":"2020","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"3","key":"pcbi.1013096.ref034","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1046\/j.1469-0705.2000.00068.x","article-title":"Fetal aortic arch measurements between 14 and 38 weeks\u2019 gestation: in-utero ultrasonographic study","volume":"15","author":"R Achiron","year":"2000","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"pcbi.1013096.ref035","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/S1230-8013(11)70022-4","article-title":"The development of the aortic isthmus in human fetal life","volume":"18","author":"D Nowak","year":"2011","journal-title":"Polish Ann Medicine"},{"key":"pcbi.1013096.ref036","doi-asserted-by":"crossref","unstructured":"Arduini D, Rizzo G. Normal values of Pulsatility Index from fetal vessels: A cross-sectional study on 1556 healthy fetuses. vol. 18. 1990.","DOI":"10.1515\/jpme.1990.18.3.165"},{"issue":"1","key":"pcbi.1013096.ref037","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1002\/uog.22152","article-title":"Fetal cardiac filling and ejection time fractions by pulsed-wave Doppler: reference ranges and potential clinical application","volume":"58","author":"I Soveral","year":"2021","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"4","key":"pcbi.1013096.ref038","first-page":"475","article-title":"The role of ventricular disproportion, aortic, and ductal isthmus ultrasound measurements for the diagnosis of fetal aortic coarctation, in the third trimester of pregnancy","volume":"17","author":"C M\u0103rginean","year":"2015","journal-title":"Med Ultrason"},{"issue":"3","key":"pcbi.1013096.ref039","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s12265-022-10335-9","article-title":"Learning the Hidden Signature of Fetal Arch Anatomy: a Three-Dimensional Shape Analysis in Suspected Coarctation of the Aorta","volume":"16","author":"U Hermida","year":"2023","journal-title":"J Cardiovasc Transl Res"},{"issue":"2","key":"pcbi.1013096.ref040","first-page":"203","article-title":"Coarctation of the aorta explained as a branch-point of the ductus arteriosus","volume":"63","author":"GM Hutchins","year":"1971","journal-title":"Am J Pathol"},{"key":"pcbi.1013096.ref041","doi-asserted-by":"crossref","unstructured":"Gim\u00e9nez P, Bijnens B, Bernardino G, Lluch \u00c8, Soveral I, G\u00f3mez O. Assessment of haemodynamic remodeling in fetal aortic coarctation using a lumped model of the circulation. In: Lect Notes Comput Sci. Springer Verlag. 2017. 471\u201380. doi: 10.1007\/978-3-319-59448-4_45","DOI":"10.1007\/978-3-319-59448-4_45"},{"key":"pcbi.1013096.ref042","unstructured":"Becker A, Becker M, Edwards J. Anomalies associated with coarctation of aorta particular reference to infancy. 2025."},{"issue":"12","key":"pcbi.1013096.ref043","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1111\/echo.13644","article-title":"Modeling of coarctation of aorta in human fetuses using 3D\/4D fetal echocardiography and computational fluid dynamics","volume":"34","author":"Z Chen","year":"2017","journal-title":"Echocardiography"},{"issue":"1","key":"pcbi.1013096.ref044","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1002\/uog.2827","article-title":"Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy","volume":"28","author":"M Del R\u00edo","year":"2006","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pcbi.1013096.ref045","first-page":"102","author":"MZ Gurvitz","year":"2009"},{"issue":"2","key":"pcbi.1013096.ref046","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s00246-016-1520-6","article-title":"Toward Improving the Fetal Diagnosis of Coarctation of the Aorta","volume":"38","author":"M Beattie","year":"2017","journal-title":"Pediatr Cardiol"},{"issue":"1","key":"pcbi.1013096.ref047","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/uog.11161","article-title":"Sonographic predictors of surgery in fetal coarctation of the aorta","volume":"40","author":"V Jowett","year":"2012","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"11","key":"pcbi.1013096.ref048","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.echo.2019.06.011","article-title":"The Diastolic and Systolic Velocity-Time Integral Ratio of the Aortic Isthmus Is a Sensitive Indicator of Aortic Coarctation in Fetuses","volume":"32","author":"H Wang","year":"2019","journal-title":"J Am Soc Echocardiogr"}],"container-title":["PLOS Computational Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1013096","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T20:03:04Z","timestamp":1748635384000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1013096"}},"subtitle":[],"editor":[{"given":"Andrew D.","family":"McCulloch","sequence":"first","affiliation":[]}],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":48,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pcbi.1013096","relation":{},"ISSN":["1553-7358"],"issn-type":[{"value":"1553-7358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]}}}