Main Patterns of Fetal Cardiac Remodeling

Abstract

The heart is a central organ in the fetal adaptation to an adverse environment. Fetal cardiac changes may persist postnatally and increase the risk of cardiovascular disease in adulthood. Knowledge about fetal cardiac structural as well as functional remodeling has radically improved over the last few years. As it occurs in postnatal life, the fetal heart remodels -changing its structure and shape -to adapt to an insult. Several conditions have been reported to be associated with fetal cardiac remodeling including intrauterine growth restriction, diabetes, exposure to antiretroviral drugs, conception by assisted reproductive technologies, pulmonary stenosis, and other congenital heart diseases. Here we summarized the main observable patterns of cardiac remodeling, i.e., globular shape, hypertrophy without dilation, and hypertrophy with cardiomegaly. We discuss the potential pathophysiology behind different types of remodeling. Defining precisely the distinct patterns of fetal cardiac remodeling is critical for advancing in the understanding of fetal cardiovascular programming and its consequences on adult health, and potentially for the design of preventive strategies that might have an impact on long-term cardiovascular health.

Fetal Cardiac Remodeling Is Affected by the Type of Embryo Transfer in Pregnancies Conceived by in vitro Fertilization: A Prospective Cohort Study

“…The findings from this study are in line with those of previous reports showing an increased risk of fetal cardiac dysfunction in both singleton and twin pregnancies conceived by ICSI [9, 10]. These cardiac changes may persist after birth and lead to increased arterial pressure, aortic intima-media thickness, and pulmonary vascular dysfunction in childhood [9, 13-15].…”

“…Despite being associated with a higher chance of achieving pregnancy compared to medical conceptions, IVF techniques, such as intracytoplasmic sperm injection (ICSI), may car-Fetal Diagn Ther 2020;47:772-778 DOI: 10.1159/000508987 ry an increased risk of obstetric complications, including pre-eclampsia, preterm birth, impaired placental function, and structural malformations, when compared to naturally conceived gestations [3][4][5][6][7][8]. More recently, pregnancies conceived by ICSI have been also reported to be associated with abnormal fetal cardiac function, mainly consisting in a remodeling of ventricular shape, change in atrial area, and impaired systolic and diastolic function, which can persist after birth, potentially leading to systemic and pulmonary vascular dysfunction during childhood [9][10][11][12][13][14][15][16]. Although the pathophysiology of these changes has still to be fully elucidated, epigenetic changes secondary to early embryo manipulation, hormonal effects, or placental development may play a pivotal role in inducing such modifications [9,17,18].…”

Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks

“…Fetal cardiac remodeling is present in CHD [3][4][5][6] and other prenatal conditions, such as conception by assisted reproductive techniques (ART) 7 , fetal growth restriction (FGR) 8 , maternal diabetes 9 and drug exposure 10 . Accurate measurement of fetal cardiac, ventricular and atrial size and geometry is essential to assess the patterns of cardiac remodeling 11 and help understand and monitor fetal cardiac adaptations to an adverse environment.…”

Biomechanics of Human Fetal Hearts with Critical Aortic Stenosis

“…Concentric hypertrophy is typically found in pressure overload situations, such as during fetal AS, while eccentric hypertrophy can be found in fetal growth restriction cases. 5 In our study, we have modelled only concentric hypertrophy. An increase in LV wall thickness was found to have a significant effect on the hemodynamics and LV function.…”