Jonker SS, Faber JJ, Anderson DF, Thornburg KL, Louey S, Giraud GD. Sequential growth of fetal sheep cardiac myocytes in response to simultaneous arterial and venous hypertension. Am J Physiol Regul Integr Comp Physiol 292: R913-R919, 2007. First published October 5, 2006; doi:10.1152/ajpregu.00484.2006.-While the fetal heart grows by myocyte enlargement and proliferation, myocytes lose their capacity for proliferation in the perinatal period after terminal differentiation. The relationship between myocyte enlargement, proliferation, and terminal differentiation has not been studied under conditions of combined arterial and venous hypertension, as occurs in some clinical conditions. We hypothesize that fetal arterial and venous hypertension initially leads to cardiomyocyte proliferation, followed by myocyte enlargement. Two groups of fetal sheep received intravascular plasma infusions for 4 or 8 days (from 130 days gestation) to increase vascular pressures. Fetal hearts were arrested in diastole and dissociated. Myocyte size, terminal differentiation (%binucleation), and cell cycle activity cells as a % of mononucleated myocytes) were measured. We found that chronic plasma infusion greatly increased venous and arterial pressures. Heart (but not body) weights were ϳ30% greater in hypertensive fetuses than controls. The incidence of cell cycle activity doubled in hypertensive fetuses compared with controls. After 4 days of hypertension, myocytes were (ϳ11%) longer, but only after 8 days were they wider (ϳ12%). After 8 days, %binucleation was ϳ50% greater in hypertensive fetuses. We observed two phases of cardiomyocyte growth and maturation in response to fetal arterial and venous hypertension. In the early phase, the incidence of cell cycle activity increased and myocytes elongated. In the later phase, the incidence of cell cycle activity remained elevated, %binucleation increased, and cross sections were greater. This study highlights unique fetal adaptations of the myocardium and the importance of experimental duration when interpreting fetal cardiac growth data.hypertrophy; hyperplasia; terminal differentiation; cardiomyocyte THE FETAL HEART GROWS BY PROLIFERATION and enlargement of cardiac myocytes (23). Among mammals, proliferative growth of cardiac myocytes ceases at or soon after birth through a process known as terminal differentiation (18). Thereafter, the postnatal heart grows almost exclusively by cellular enlargement. In the fetal sheep, as in many other species, terminal differentiation is marked by the appearance of two nuclei in cardiac myocytes that were formerly mononucleated. The rate of proliferation during intrauterine life and the occurrence of terminal differentiation in the perinatal period together determine the maximum number of myocytes in the heart for life.Intrauterine conditions affect cardiac myocyte proliferation, enlargement, and terminal differentiation, but myocyte responses to abnormal conditions depend on the level of maturity of the heart. Increased systolic or diastolic hemo...