Cardiac Embryology and Molecular Mechanisms of Congenital Heart Disease: A Primer for Anesthesiologists

Abstract

Congenital heart disease is diagnosed in 0.4% to 5% of live births and presents unique challenges to the pediatric anesthesiologist. Furthermore, advances in surgical management have led to improved survival of those patients, and many adult anesthesiologists now frequently take care of adolescents and adults who have previously undergone surgery to correct or palliate congenital heart lesions. Knowledge of abnormal heart development on the molecular and genetic level extends and improves the anesthesiologist's understanding of congenital heart disease. In this paper we aim to review current knowledge pertaining to genetic alterations and their cellular effects that are involved in the formation of congenital heart defects. Given that congenital heart disease can currently only occasionally be traced to a single genetic mutation, we highlight some of the difficulties that researchers face when trying to identify specific steps in the pathogenetic development of heart lesions.

Associations of Assisted Reproductive Technology and Twin Pregnancy With Risk of Congenital Heart Defects

“…10,14,26 Congenital heart defect is a serious disease burden not only in infants but also in adolescents and adults. [27][28][29] The pathophysiologic findings and pathogenesis of CHD are complicated and often are very different from other congenital anomalies. 12,13,30,31 The American Institute of Ultrasound in Medicine, in collaboration with other professional organizations, has developed the Fetal Echocardiography Practice Parameter, 32 and the American College of Radiology has endorsed this document.…”

The Other Side of the Fascia: Visceral Fascia, Part 2

“…The lateral plate mesoderm splits into parietal (somatic) and visceral (splanchnic) layers: the parietal layer forms the lateral body wall folds and the skeletal striated muscle, and the visceral mesoderm forms the walls of the gut tube [10]. According to other authors, there is a fourth mesodermal layer that will give rise to cardiac tissue: the cardiogenic mesoderm [11]. Cells from the cardiogenic mesoderm will migrate cranially to laterally by enveloping the cranial neural crests; this formation is called the first heart field.…”

“…The second heart field derives from the anterior lateral plate mesoderm, located medially and caudally to the first heart field [12]. From the anterior lateral plate mesoderm, on both sides, will derive two sets of cells which fuse to form a single primitive heart tube by coalescence; the tube consists of myocardial cells (myocardium) and endothelial cells (endocardium) [11]. An extracellular matrix (ECM) divides the two types of cells.…”

Challenges in assessing the use of antibiotics during pregnancy and risk of congenital malformations

“…The authors used “prevalence odds ratios” to quantify the association between ventricular/atrial septal defect and exposure to the doxycycline within the first trimester (12 weeks) of pregnancy. Thus, it is possible that doxycycline exposure could have occurred after the formation of ventricular/atrial septal defect, since congenital heart defect occurs when normal heart development is disrupted during the first eight weeks of pregnancy . In addition, it may be helpful if dosage information had been provided and considered…”

“…1 The findings and conclusions, specifically regarding doxycycline, of pregnancy. 2,3 In addition, it may be helpful if dosage information had been provided and considered. 4 2.…”