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

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 Received: February 25, 2016 Accepted after revision: May 11, 2016 Published online: July 6, 2016 Prof. Alec W. Welsh University of New South Wales Royal Hospital for Women Barker St., 2031 Randwick, NSW (Australia) E-Mail alec.welsh @ unsw.edu.au © 2016 S. Karger AG, Basel 1015–3837/16/0402–0081$39.50/0