Fetal hemodynamics

Brezinka, Christoph

doi:10.1515/jpm.2001.053

Cited by 19 publications

(12 citation statements)

References 33 publications

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“…With fresh O 2 from the placenta, the erythrocytes move in an accelerating continuous flow along the umbilical vein to the ductus venosus. After having reached the left ventricle again, the blood now passes through a coronary artery to the right atrium and eventually the ductus arteriosus or the pulmonary circulation [36]. Venous return of fetal circulation consists of 70% blood from the lower body and of 30% blood from the upper body.…”

Section: Embryology Anatomy and Pathophysiology Of Fetal Heart And mentioning

confidence: 99%

Advances in fetal cardiology

Comparetto

Borruto

2014

Evidence Based Womenʼs Health Journal

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The prevalence of congenital heart malformations as a whole (including diseases of little clinical significance) is 0.8% (8 of 1000 live births). The most frequent pathologies are malformations that prevent blood from reaching the lungs to take oxygen or block the normal supply of oxygenated blood to the body. The transposition of the great vessels (the aorta and pulmonary artery originate from the 'wrong' ventricles) is important as it represents the most severe neonatal heart disease. A separate issue, instead, is that of arrhythmias. The diagnosis is made around the 20th-21st week of gestation through a targeted ultrasound examination of fetal heart. This enables the recognition of the vast majority (around 85%) of clinically important congenital heart diseases (CHD) at birth. Nevertheless, targeted examinations are not possible for all pregnancies: the costs would not allow it. They are still available for patients who have recognized risk factors (they had children with previous CHD, they took teratogenic drugs, or they have diabetes), whereas pregnant women who have a very low risk are subjected to basic ultrasound examinations. An ultrasound examination allows at least suspicion of a significant proportion (30-40%) of important heart diseases. Progresses in the diagnostic field are continuous and the development of visualization techniques provides great opportunities. Four-dimensional (4-D) ultrasound that allows volumetrical viewing of the fetus, moving, to the most detailed facial expressions, appears to be promising in the diagnosis of CHD, which often escape the traditional ultrasound examination. Enabling better visualization of the heart, thanks to the ability to view it from different points and angles, volumetric ultrasound could aid the diagnosis of more heart diseases. Recognition of fetuses with heart disease may be useful for planning targeted interventions. The purpose of prenatal diagnosis is, first, to improve the prognosis without serious damages in the neonatal period. If necessary, there is the possibility of interventions on the fetus (which mainly consists of aortic or pulmonary valve and foramen ovale dilation), but they are still experimental cardiac procedures. In general, the first interventions take place on the newborn baby; therefore, the birth can be arranged at a cardiology and cardiac surgery unit, thus avoiding delays and dangerous transfers. Thanks to the timely diagnosis, today, 90% of operated babies survive and reach adulthood with a normal life expectancy (only for patients with univentricular heart, we impose limits on physical and working activity). Today, complex operations are possible even in low-birth-weight babies, with very good results, attempting to prioritize corrective radical rather than palliative solutions, which until recently were often the only options. As medical therapies play a marginal role in heart malformations, they are instead essential in the treatment of fetal tachyarrhythmias: these are quite rare diseases, which are also detectable by echoc...

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Section: Embryology Anatomy and Pathophysiology Of Fetal Heart And mentioning

confidence: 99%

Advances in fetal cardiology

Comparetto

Borruto

2014

Evidence Based Womenʼs Health Journal

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“…The placenta becomes a major component of the cardiovascular system between the eighth and tenth weeks [81]. Blood is pumped by the fetal heart through the umbilical arteries to the placenta, where replenished with oxygen and nutrients it returns via the umbilical vein [82]. Placental blood is part of the fetal circulatory system, as much as pulmonary blood is after birth.…”

Section: Placental Blood Is Respiratory Bloodmentioning

confidence: 99%

Review--Birth brain injury: etiology and prevention--Part II: The premature child and cesarean section deliveries

Morley¹

2005

Medical Veritas

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Hypoxia and hypovolemia produced by experimental birth asphyxia in primates can affect memory ability and development of the adult brain; in humans, hypovolemia produced by ICC and the resultant infant anemia is strongly correlated with behavioral and learning disorders in children, the degree of anemia being proportional to the degree of mental deficiency.Autism comprises a major portion of these disabilities and is epidemic. Autism occurs more frequently after complicated or difficult births that indicate the use of ICC. The clinical features of autism indicate lesions of the auditory, speech and language areas of the brain to be fundamental. Hypoxic-ischemic birth injury to the inferior colliculi (part of the auditory circuit) could account for the later development of autism.Mercury toxicity from vaccines as a cause of autism is controversial and is still under investigation; mercury accumulation in brain nuclei already damaged by hypoxia-ischemia (in the same manner that bilirubin accumulates in dead tissue but does not stain living tissue) may have led researchers to attribute the damage to an incidental finding and miss the real cause.There is considerable evidence that the autism epidemic will end when the current custom of clamping functioning umbilical cords ends.

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“…The fetal aortic arch has two inlets represented by the right and left ventricular outflow tracks (RVOT and LVOT), and distributes oxygenated blood from the placenta and deoxygenated blood from the fetus via two outlets represented by the ascending aorta and pulmonary arteries to the head-neck vessels and the descending aorta (DAo) (Brezinka, 2001;Long, 1990;Sadler, 2006). The fetal aortic arch is in constant transformation in order to optimally match the hemodynamic requirements of the growing embryo .…”

Section: Introductionmentioning

confidence: 99%

In vitro hemodynamic investigation of the embryonic aortic arch at late gestation

Pekkan

Dasi

Nourparvar

et al. 2008

Journal of Biomechanics

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This study focuses on the dynamic flow through the fetal aortic arch driven by the concurrent action of right and left ventricles. We created a parametric pulsatile computational fluid dynamics (CFD) model of the fetal aortic junction with physiologic vessel geometries. To gain a better biophysical understanding an in vitro experimental fetal flow loop for flow visualization was constructed for identical CFD conditions. CFD and in vitro experimental results were comparable.Swirling flow during the acceleration phase of the cardiac cycle and unidirectional flow following mid-deceleration phase were observed in pulmonary arteries (PA), head-neck vessels, and descending aorta. Right-to-left (oxygenated) blood flowed through the ductus arteriosus (DA) posterior relative to the antegrade left ventricular outflow tract (LVOT) stream and resembled jet flow. LVOT and right ventricular outflow tract flow mixing had not completed until ~3.5 descending aorta diameters downstream of the DA insertion into the aortic arch. Normal arch model flow patterns were then compared to flow patterns of four common congenital heart malformations that include aortic arch anomalies. Weak oscillatory reversing flow through the DA junction was observed only for the Tetralogy of Fallot configuration. Pulmonary Atresia and Hypoplastic Left Heart Syndrome configurations demonstrated complex, abnormal flow patterns in the PAs and head-neck vessels. Aortic Coarctation resulted in large scale recirculating flow in the aortic arch proximal to the DA. Intravascular flow patterns spatially correlated with abnormal vascular structures consistent with the paradigm that abnormal intravascular flow patterns associated with congenital heart disease influence vascular growth and function.

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Fetal hemodynamics

Cited by 19 publications

References 33 publications

Advances in fetal cardiology

Advances in fetal cardiology

Review--Birth brain injury: etiology and prevention--Part II: The premature child and cesarean section deliveries

In vitro hemodynamic investigation of the embryonic aortic arch at late gestation

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