Abstract
This chapter will review the transition from the fetal to the neonatal circulation. First, it will describe the prenatal hemodynamics throughout gestation in the developing fetus with a normal heart. Second, it will compare hemodynamics of the normal fetus with the flow patterns and distribution of cardiac output in the fetus with structural cardiac defects, concentrating on severe and ductal-dependent cardiac anomalies. Third, it will describe the postnatal hemodynamics with implications for neonatal management of the infant with structural cardiac defects.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lees C, Albaiges G, Deane C, Parra M, Nicolaides KH (1999) Assessment of umbilical arterial and venous flow using color Doppler. Ultrasound Obstet Gynecol 14(4):250–255
Sutton MS, Theard MA, Bhatia SJ, Plappert T, Saltzman DH, Doubilet P (1990) Changes in placental blood flow in the normal human fetus with gestational age. Pediatr Res 28(4):383–387
Rizzo G, Arduini D, Romanini C (1992) Accelerated cardiac growth and abnormal cardiac flow in fetuses of type I diabetic mothers. Obstet Gynecol 80:369–376
Kiserud T (2000) Fetal venous circulation – an update on hemodynamics. J Perinat Med 28(2):90–96
Kiserud T, Rasmussenk S, Skulstad S (2000) Blood flow and the degree of shunting through the ductus venosus in the human fetus. Am J Obstet Gynecol 182:147–153
Adeagbo AS, Coceani F, Olley PM (1982) The response of the lamb ductus venosus to prostaglandins and inhibitors of prostaglandin and thromboxane synthase. Circ Res 51(5):580–586
Coceani F, Adeagbo AS, Cutz E, Olley PM (1984) Autonomic mechanisms in the ductus venosus of the lamb. Am J Physiol 247:H17–H24
Kiserud T, Ozaki T, Nishina H, Rodeck C, Hanson MA (2000) Effect of NO, phenylephrine, and hypoxemia on ductus venosus diameter in fetal sheep. Am J Physiol Heart Circ Physiol 279(3):H1166–H1171
Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR (1991) Ultrasonographic velocimetry of the fetal ductus venosus. Lancet 338(8780):1412–1414
Kiserud T (1999) Hemodynamics of the ductus venosus. Eur J Obstet Gynecol Reprod Biol 84(2):139–147
Sutton MS, Groves A, MacNeill A, Sharland G, Allan L (1994) Assessment of changes in blood flow through the lungs and foramen ovale in the normal human fetus with gestational age: a prospective Doppler echocardiographic study. Br Heart J 71(3):232–237
Wilson AD, Rao PS, Aeschlimann S (1990) Normal fetal foramen flap and transatrial Doppler velocity pattern. J Am Soc Echocardiogr 3(6):491–494
Levin DL, Rudolph AM, Heymann MA, Phibbs RH, Lister G (1976) Morphological development of the pulmonary vascular bed in fetal lambs. Circulation 53(1):144–151
Rudolph AM, Heymann MA (1970) Circulatory changes during growth in the fetal lamb. Circ Res 26(3):289–299
Laudy JA, de Ridder MA, Wladimiroff JW (2000) Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels. Ultrasound Obstet Gynecol 16(3):284–290
Sivan E, Rotstein Z, Lipitz S, Sevillia J, Achiron R (2000) Segmentary fetal branch pulmonary artery blood flow velocimetry: in utero Doppler study. Ultrasound Obstet Gynecol 16(5):453–456
Rasanen J, Huhta JC, Weiner S, Wood DC, Ludomirski A (1996) Fetal branch pulmonary arterial vascular impedance during the second half of pregnancy. Am J Obstet Gynecol 174(5):1441–1449
Rasanen J, Wood DC, Debbs RH, Cohen J, Weiner S, Huhta JC (1998) Reactivity of the human fetal pulmonary circulation to maternal hyperoxygenation increases during the second half of pregnancy: a randomized study. Circulation 97(3):257–262
Broth RE, Wood DC, Rasanen J, Sabogal JC, Komwilaisak R, Weiner S, Berghella V (2002) Prenatal prediction of lethal pulmonary hypoplasia: the hyperoxygenation test for pulmonary artery reactivity. Am J Obstet Gynecol 187(4):940–945
Szwast A, Tian Z, McCann M, Donaghue D, Rychik J (2010) Vasoreactive response to maternal hyperoxygenation in the fetus with hypoplastic left heart syndrome. Circ Cardiovasc Imaging 3(2):172–178
van Splunder P, Stijnen T, Wladimiroff JW (1996) Fetal atrioventricular flow-velocity waveforms and their relation to arterial and venous flow-velocity waveforms at 8 to 20 weeks of gestation. Circulation 94(6):1372–1378
Pacileo G, Paladini D, Russo MG, Pisacane C, Santoro G, Calabrò R (2000) Echocardiographic assessment of ventricular filling pressure during the second and third trimesters of gestation. Ultrasound Obstet Gynecol 16(2):128–132
De Smedt MC, Visser GH, Meijboom EJ (1987) Fetal cardiac output estimated by Doppler echocardiography during mid- and late gestation. Am J Cardiol 60(4):338–342
Wladimiroff JW, Stewart PA, Burghouwt MT, Stijnen T (1992) Normal fetal cardiac flow velocity waveforms between 11 and 16 weeks of gestation. Am J Obstet Gynecol 167(3):736–739
Brezinka C, Huisman TW, Stijnen T, Wladimiroff JW (1992) Normal Doppler flow velocity waveforms in the fetal ductus arteriosus in the first half of pregnancy. Ultrasound Obstet Gynecol 2(6):397–401
Huhta JC, Cohen AW, Wood DC (1990) Premature constriction of the ductus arteriosus. Am J Obstet Gynecol 162(1):199–202
Tulzer G, Gudmundsson S, Sharkey AM, Wood DC, Cohen AW, Huhta JC (1991) Doppler echocardiography of fetal ductus arteriosus constriction versus increased right ventricular output. J Am Coll Cardiol 18(2):532–536
Wladimiroff JW, Tonge HM, Stewart PA (1986) Doppler ultrasound assessment of cerebral blood flow in the human fetus. Br J Obstet Gynaecol 93(5):471–475
Fouron JC (2003) The unrecognized physiological and clinical significance of the fetal aortic isthmus. Ultrasound Obstet Gynecol 22(5):441–447
Mahony L, Jones LR (1986) Developmental changes in cardiac sarcoplasmic reticulum in sheep. J Biol Chem 261(32):15257–15265
Birk E, Tyndall MR, Erickson LC, Rudolph AM, Roberts JM (1992) Effects of thyroid hormone on myocardial adrenergic beta-receptor responsiveness and function during late gestation. Pediatr Res 31(5):468–473
Lebowitz EA, Novick JS, Rudolph AM (1972) Development of myocardial sympathetic innervation in the fetal lamb. Pediatr Res 6(12):887–893
Friedman WF (1972) The intrinsic physiological properties of the developing heart. Prog Cardiovasc Dis 15:87–111
Thornburg KL, Morton MJ (1986) Filling and arterial pressures as determinants of left ventricular stroke volume in fetal lambs. Am J Physiol 251(5 Pt 2):H961–H968
Reller MD, Morton MJ, Reid DL, Thornburg KL (1987) Fetal lamb ventricles respond differently to filling and arterial pressures and to in utero ventilation. Pediatr Res 22(6):621–626
Sweeney LJ, Zak R, Manasek FJ (1987) Transitions in cardiac isomyosin expression during differentiation of the embryonic chick heart. Circ Res 61:287–295
Mahony L (1996) Calcium homeostasis and control of contractility in the developing heart. Semin Perinatol 20(6):510–519
Grant DA, Maloney JE, Tyberg JV, Walker AM (1992) Effects of external constraint on the fetal left ventricular function curve. Am Heart J 123(6):1601–1609
Hawkins J, Van Hare GF, Schmidt KG, Rudolph AM (1989) Effects of increasing afterload on left ventricular output in fetal lambs. Circ Res 65(1):127–134
Nassar R, Reedy MC, Anderson PA (1987) Developmental changes in the ultrastructure and sarcomere shortening of the isolated rabbit ventricular myocyte. Circ Res 61(3):465–483
Ingwall JS, Kramer MF, Woodman D, Friedman WF (1981) Maturation of energy metabolism in the lamb: changes in myosin ATPase and creatine kinase activities. Pediatr Res 15:1128–1133
Nakanishi T, Okuda H, Kamata K, Abe K, Sekiguchi M, Takao A (1987) Development of myocardial contraction system in the fetal rabbit. Pediatr Res 22:201–207
Chattergoon NN, Giraud GD, Thornburg KL (2007) Thyroid hormone inhibits proliferation of fetal cardiac myocytes in vitro. J Endocrinol 192(2):R1–R8
Rudolph AM (2001) Congenital diseases of the heart: clinical physiological considerations, 2nd edn. Futura, Armonk
Mielke G, Benda N (2001) Cardiac output and central distribution of blood flow in the human fetus. Circulation 103(12):1662–1668
Kenny JF, Plappert T, Doubilet P, Saltzman DH, Cartier M, Zollars L, Leatherman GF, St. John Sutton MG (1986) Changes in intracardiac blood flow velocities and right and left ventricular stroke volumes with gestational age in the normal human fetus: a prospective Doppler echocardiographic study. Circulation 74(6):1208–1216
Soyeur D, Schaaps J-P, Kulbertus H (1990) Pulsed Doppler assessment of fetal blood flow across the foramen ovale and pulmonary vascular bed [Abstract]. Eur Heart J 11:90
St. John Sutton MG, Gewitz MH, Shah B, Cohen A, Reichek N, Gabbe S, Huff DS (1984) Quantitative assessment of growth and functions of the cardiac chambers in the normal human fetus: a prospective longitudinal echocardiographic study. Circulation 69(4):645–654
Rudolph AM (1985) Distribution and regulation of blood flow in the fetal and neonatal lamb. Circ Res 57(6):811–821
Ivy DD, Kinsella JP, Abman SH (1994) Physiologic characterization of endothelin a and B receptor activity in the ovine fetal pulmonary circulation. J Clin Invest 93(5):2141–2148
Ziegler JW, Ivy DD, Kinsella JP, Abman SH (1995) The role of nitric oxide, endothelin, and prostaglandins in the transition of the pulmonary circulation. Clin Perinatol 22(2):387–403
Heymann MA, Rudophy AM (1972) Effect of congenital heart disease on fetal and neonatal circulations. Prog Cardiovasc Res 15:115–143
Itsukaichi M, Kikuchi A, Yoshihara K, Serikawa T, Takakuwa K, Tanaka K (2011) Changes in fetal circulation associated with congenital heart disease and their effects on fetal growth. Fetal Diagn Ther 30(3):219–224
Hinton RB, Andelfinger G, Sekar P, Hinton AC, Gendron RL, Michelfelder EC, Robitaille Y, Benson DW (2008) Prenatal head growth and white matter injury in hypoplastic left heart syndrome. Pediatr Res 64(4):364–369
Vyas S, Nicolaides KH, Bower S, Campbell S (1990) Middle cerebral artery flow velocity waveforms in fetal hypoxaemia. Br J Obstet Gynaecol 97:797–803
Wladimiroff JW, van Wijngaard JA, Degani S et al (1987) Cerebral and umbilical arterial blood flow velocity waveforms in normal and growth retarded pregnancies. Obstet Gynecol 69:705–709
Berg C, Gembruch O, Gembruch U, Geipel A (2009) Doppler indices of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery in utero: is there a brain-sparing effect? Ultrasound Obstet Gynecol 34:666–672
Donofrio MT, Bremer YA, Schieken RM, Gennings C, Morton LD, Eidem BW, Cetta F, Falkensammer CB, Huhta JC, Kleinman CS (2003) Autoregulation of cerebral blood flow in fetuses with congenital heart disease: the brain sparing effect. Pediatr Cardiol 24(5):436–443
Kaltman JR, Di H, Tian Z, Rychik J (2005) Impact of congenital heart disease on cerebral blood flow dynamics in the fetus. Ultrasound Obstet Gynecol 23:32–36
Taketazu M, Barrea C, Smallhorn JF, Wilson GJ, Hornberger LK (2004) Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome. J Am Coll Cardiol 43(10):1902–1907
Javois AJ, Van Bergen AH, Cuneo BF, Husayni TS (2005) Novel approach to the newborn with hypoplastic left heart syndrome and intact atrial septum. Catheter Cardiovasc Interv 66(2):268–272
Andrews RE, Tibby SM, Sharland GK, Simpson JM (2008) Prediction of outcome of tricuspid valve malformations diagnosed during fetal life. Am J Cardiol 101(7):1046–1050
McElhinney DB, Salvin JW, Colan SD, Thiagarajan R, Crawford EC, Marcus EN, del Nido PJ, Tworetzky W (2005) Improving outcomes in fetuses and neonates with congenital displacement (Ebstein’s malformation) or dysplasia of the tricuspid valve. Am J Cardiol 96(4):582–586
Sharland GK, Sk C, Allan LD (1991) Tricuspid valve dysplasia or displacement in intrauterine life. J Am Coll Cardiol 17(4):944–949
Barre E, Durand I, Hazelzet T, David N (2012) Ebstein’s anomaly and tricuspid valve dysplasia: prognosis after diagnosis in utero. Pediatr Cardiol 33(8):1391–1396
Inamura N, Taketazu M, Smallhorn JF, Hornberger LK (2005) Left ventricular myocardial performance in the fetus with severe tricuspid valve disease and tricuspid insufficiency. Am J Perinatol 22(2):91–97
Wald RM, Adatia I, Van Arsdell GS, Hornberger LK (2005) Relation of limiting ductal patency to survival in neonatal Ebstein’s anomaly. Am J Cardiol 96(6):851–856
Jouannic JM, Benachi A, Bonnet D, Fermont L, Le Bidois J, Dumez Y, Dommergues M (2002) Middle cerebral artery Doppler in fetuses with transposition of the great vessels. Ultrasound Obstet Gynecol 20:122–124
Oberhänsli-Weiss I, Heymann MA, Rudolph AM, Melmon KL (1972) The pattern and mechanical response of the ductus arteriosus and umbilical artery to oxygen. Pediatr Res 6:693–700
McMurphy DM, Heymann MA, Rudolph AM, Melmon KL (1972) Developmental changes in constriction of the ductus arteriosus: responses to oxygen and vasoactive agents in the isolated ductus arteriosus of the fetal lamb. Pediatr Res 6(4):231–238
Rudolph AM (2007) Aortopulmonary transposition in the fetus: speculation on pathophysiology and therapy. Pediatr Res 61(3):375–380
Walther FJ, Benders MJ, Leighton JO (1993) Early changes in the neonatal circulatory transition. J Pediatr 123(4):625–632
Teitel DF (1988) Circulatory adjustments to postnatal life [Review]. Semin Perinatol 12(2):96–103
Winberg P, Jansson M, Marions L, Lundell BP (1989) Left ventricular output during postnatal circulatory adaptation in healthy infants born at full term. Arch Dis Child 64(Spec No 10):1374–1378
Lister G, Walter TK, Versmold HT, Dallman PR, Rudolph AM (1979) Oxygen delivery in lambs: cardiovascular and hematologic development. Am J Physiol 237(6):H668–H675
Sidi D, Kuipers JR, Heymann MA, Rudolph AM (1983) Effects of ambient temperature on oxygen consumption and the circulation in newborn lambs at rest and during hypoxemia. Pediatr Res 17(4):254–258
Teitel DF, Sidi D, Chin T, Brett C, Heymann MA, Rudolph AM (1985) Developmental changes in myocardial contractile reserve in the lamb. Pediatr Res 19(9):948–955
Rudolph AM, Roman C, Gournay V (1999) Perinatal myocardial DNA and protein changes in the lamb: effect of cortisol in the fetus. Pediatr Res 46(2):141–146
Hornberger LK, Sahn DJ, Kleinman CS, Copel JA, Reed KL (1991) Tricuspid valve disease with significant tricuspid insufficiency in the fetus: diagnosis and outcome. J Am Coll Cardiol 17(1):167–173
Punn R, Silverman NH (2011) Fetal predictors of urgent balloon atrial septostomy in neonates with complete transposition. J Am Soc Echocardiogr 24(4):425–430
Jouannic JM, Gavard L, Fermont L et al (2004) Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries. Circulation 110(13):1743–1746
Reed KL, Meijboom EJ, Sahn DJ, Scagnelli SA, Valdes-Cruz LM, Shenker L (1986) Cardiac Doppler flow velocities in human fetuses. Circulation 73(1):41–46
Lewis AB, Heymann MA, Rudolph AM (1976) Gestational changes in pulmonary vascular responses in fetal lambs in utero. Circ Res 39(4):536–541
Arduini D, Rizzo G, Romanini C (1992) Obstet Gynecol 79(4):605–610
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag London
About this entry
Cite this entry
Cuneo, B. (2014). Transition from Fetal to Neonatal Circulation. In: Da Cruz, E., Ivy, D., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4619-3_155
Download citation
DOI: https://doi.org/10.1007/978-1-4471-4619-3_155
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-4618-6
Online ISBN: 978-1-4471-4619-3
eBook Packages: MedicineReference Module Medicine