![]() ![]() ![]() The heart undergoes a unique combination of morphological and physiological changes to reach an anatomical maturity while maintaining the circulatory needs of the developing embryo. The cardiac functional development in early pregnancy is not well know so,ĭoppler techniques is able to study early human fetal cardiac function indirectly, and it have made it possible to examine the human fetal heart and vessel non invasively and to determine normal and abnormal cardiovascular in early phases of pregnancy ( 11). The cardiac flow velocities are influenced by preload, contractile function, afterload and heart rate. Not surprisingly, ventricular loading is affected by the maturation of structures such as the placenta and changes in the impedance of the cerebral and placental vascular beds in response to hypoxaemia, as well as circulatory adaptations made by the fetus in response to intracardiac malformations ( 10). Hence the fetal right ventricle pumps against the systemic pressures of the lower fetal body and placental impedance, while the left ventricle ejects against the relatively high impedance of the fetal brain and upper body. The right ventricle fills from mostly upper body systemic venous return and the majority of its output is diverted away from the pulmonary circulation, via the arterial duct, to the descending aorta and thence to the placenta via the umbilical arteries. Left ventricular filling depends predominantly on patency of the oval foramen to allow the relatively oxygen-rich blood returning from the placental circulation, via the umbilical vein and venous duct, to stream through the right atrium and enter the left side of the heart ( 9). Pulmonary venous return contributes only a small proportion to left ventricular preload because of the relatively low pulmonary blood flow in fetal life ( 8). ![]() Three important communications exist between the two circulations (oval foramen and the arterial and venous ducts) that influence loading conditions. The fetal circulation works in parallel with the dominant right ventricle, ejecting approximately 60% of the combined ventricular output. The initial elevation of the HR coincides with the morphological development of the heart, and the subsequent decline can result from the functional maturation of the parasympathetic nervous system ( 7). From then on, there is a gradual reduction in the HR that reaches a mean value of 150 bpm at the 13th week of gestation. It is well documented in the literature that, in healthy fetuses, the heart rate (HR) increases from 110 bpm at the 5th week of gestation to 170 bpm at the 9th week of gestation. The heart, whose development starts at the 3rd week of gestation, has rapid and irregular contractions capable of pumping the blood inside the vessels.Īt this period, the developing circulatory system allows maternal- embryonic nutritive and gaseous changes at the chorionic villi. Both circulations can be altered by changes at the placental, cardiac, central nervous system, and peripheric levels.Īt the end of the 4th week of gestation, the heartbeats of the embryo begin. Two types of circulation unite these organs: on one side, the venous circulation, and on the other, the arterial circulation. Heart and placenta are the main organs determining fetal hemodynamics. Cardiac function is the first sign of independent cardiac activity that can be explored with non-invasive techniques such as Doppler ultrasound ( 5). Cardiovascular development in a human embryo occurs between 3 and 6 weeks after ovulation. Finally at 14th gestational weeks there isn’t any different between these two different approaches ( 6). Smrcek et al have demostrated that at 10th-13rd gestational week transvaginal echocardiography can better show the anatomic heart details, whereas afther the 15th gestational week the transabdominal method is more usefull. Many studies have valuated the efficacies of early echocardiography and have compared these two different methods: tv and transabdominal. Echocardiographic and anatomical correlations in firsttrimester fetuses show that by 11 weeks’ gestation, the position of the fetal heart within the chest is similar to that in later gestation, and the spatial relation of the great arteries and their relative sizes are similar to those on second- trimester scans by 12 weeks’ gestation ( 5).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |