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Westerhof BE, van Gemert MJC, van den Wijngaard JP. Pressure and Flow Relations in the Systemic Arterial Tree Throughout Development From Newborn to Adult. Front Pediatr 2020; 8:251. [PMID: 32509713 PMCID: PMC7248228 DOI: 10.3389/fped.2020.00251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: Distributed models of the arterial tree allow studying the effect of physiological and pathophysiological changes in the vasculature on hemodynamics. For the adult, several models exist; however, a model encompassing the full age range from newborn to adult was until now lacking. Our goal is to describe a complete distributed hemodynamic model for normal development from newborn to adult. Methods: The arterial system was modeled by 121 segments characterized by length, radius, wall thickness, wall stiffness, and wall viscosity. The final segments ended in three-element Windkessels. All parameters were adapted based on body height and weight as a function of age as described in the literature. Results: Pressures and flows are calculated as a function of age at sites along the arterial tree. Central to peripheral transfer functions are given. Our results indicate that peripheral pressure in younger children resembles central pressure. Furthermore, total arterial compliance, inertance and impedance are calculated. Findings indicate that the arterial tree can be simulated by using a three-element Windkessel system. Pulse wave velocity in the aorta was found to increase during development. Conclusions: The arterial system, modeled from newborn to adult bears clinical significance, both for the interpretation of peripheral measured pressure in younger and older children, and for using a Windkessel model to determine flow from pressure measurements.
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Affiliation(s)
- Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, Netherlands.,Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Free Universiteit Amsterdam, Amsterdam, Netherlands.,Medical Biology, Section of Systems Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Martin J C van Gemert
- Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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da Fonseca Ferraz ML, Franco CA, Juliano GR, Juliano GR, de Almeida JA, Soares MH, Oliveira LF, Ramalho LS, Cavellani CL, Espindula AP, Corrêa RRM, de Oliveira FA, Dos Reis MA, de Paula Antunes Teixeira V. Morphometric evaluation of the aortic root in stillborns. Pathol Res Pract 2016; 212:686-9. [PMID: 27317554 DOI: 10.1016/j.prp.2016.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the dimensions and amount of collagen in the aortic root of autopsied fetuses at different gestational ages. MATERIAL AND METHODS 40 samples of aortic roots were selected from autopsied fetuses with gestational ages ranging between 20 and 40 weeks. The thickness and the area of the aortic wall were analyzed on slides stained with Hematoxylin and Eosin, and the collagen was quantified on slides stained with Picrosirius, by using an image analyzing system. RESULTS A positive correlation was observed between the thickness of the media layer of the aortic wall and the gestational age. There was a positive and significant correlation between the percentage of collagen in the aortic wall with gestational age and fetal weight. The correlation between gestational age and the area of the aortic root circumference was positive and significant. And the correlation between the aortic diameter and the gestational age as well as fetal length was positive and significant. CONCLUSION The thickness of the media layer, the amount of collagen in the aortic wall, the area of the aortic root circumference and the aortic diameter rose with the increase of the gestational age. Thus, the morphological analysis of the aortic root may help as a parameter during the follow-up of inter-uterine growth and fetal development.
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Affiliation(s)
- Mara Lúcia da Fonseca Ferraz
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Calline Alves Franco
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Gabriela Ribeiro Juliano
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Guilherme Ribeiro Juliano
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - João Antônio de Almeida
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Maria Helena Soares
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Lívia Ferreira Oliveira
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | | | - Camila Lourencini Cavellani
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Ana Paula Espindula
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Rosana Rosa Miranda Corrêa
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Flávia Aparecida de Oliveira
- General Pathology Division, Tropical Pathology and Public Health Institute (IPTSP), Goiás Federal University (UFG), Goiânia-GO, Brazil
| | - Marlene Antônia Dos Reis
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
| | - Vicente de Paula Antunes Teixeira
- General Pathology Sector, Biological and Natural Sciences Institute (ICBN), Triângulo Mineiro Federal University (UFTM), Uberaba, MG, Brazil
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Sandaite I, De Catte L, Moerman P, Gewillig M, Fedele L, Deprest J, Claus F. A morphometric study of the human fetal heart on post-mortem 3-tesla magnetic resonance imaging. Prenat Diagn 2013; 33:318-27. [DOI: 10.1002/pd.4070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Inga Sandaite
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
- Department of Obstetrics and Gynaecology, Fondazione Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Luc De Catte
- Department of Obstetrics and Gynaecology; University Hospitals Leuven; Leuven Belgium
| | - Philippe Moerman
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Luigi Fedele
- Department of Obstetrics and Gynaecology, Fondazione Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Jan Deprest
- Department of Obstetrics and Gynaecology; University Hospitals Leuven; Leuven Belgium
| | - Filip Claus
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
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Kolcz J, Skladzien T, Kordon Z, Rudzinski A, Skalski J. Impact of right ventricle-pulmonary artery conduit placement on pulmonary artery development after the Norwood procedure in hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2012; 42:218-23; discussion 223-4. [DOI: 10.1093/ejcts/ezr293] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Aortic isthmus acts as an arterial watershed between the cerebral and placental circulations, connecting 2 parallel fetal ventricular pumps. It plays a crucial role in the fetal circulatory dynamics. Information about aortic isthmus blood flow may improve the management of sick fetuses. However, perceived technical difficulties limit the clinical use of aortic isthmus Doppler for fetal hemodynamic monitoring. Changes in aortic isthmus blood flow pattern seem to reflect fetal cardiovascular status accurately and predict perinatal and long-term neurodevelopmental outcome in intrauterine growth restriction. This review evaluates the available scientific information and discusses the role of aortic isthmus in fetal circulation.
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Affiliation(s)
- Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Sykehusveien 38, N-9038 Tromsø, Norway
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Vimpeli T, Huhtala H, Wilsgaard T, Acharya G. Fetal aortic isthmus blood flow and the fraction of cardiac output distributed to the upper body and brain at 11-20 weeks of gestation. Ultrasound Obstet Gynecol 2009; 33:538-544. [PMID: 19350568 DOI: 10.1002/uog.6354] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To measure serial changes in fetal aortic isthmus (AI) blood flow and estimate the fraction of fetal cardiac output distributed to the upper body, including the brain, at 11-20 weeks of gestation. METHODS Using pulsed-wave Doppler and two-dimensional ultrasound, blood flow velocities and inner diameter of the AI, aortic valve (AV) and pulmonary valve (PV) were measured longitudinally in 143 fetuses and volume blood flows (Q) were calculated for each site using the formula: Q (mL/min) = pix (diameter/2)(2) x velocity time integral x heart rate x 60. The sum of Q(av) and Q(pv) constituted the combined cardiac output (CCO) and the fraction (%) of the upper body (including brain) blood flow was calculated as: (Q(av)-Q(ai))x100/CCO. RESULTS AI blood velocities as well as the vessel diameter increased with advancing gestation, resulting in a significant increase in Q(ai) from 1.9 to 40.5 mL/min during weeks 11 to 20. The AI peak systolic velocity increased from 29 to 63 cm/s, end-diastolic velocity from 1.2 to 5.2 cm/s, and the time-averaged maximum velocity from 11 to 22 cm/s, resulting in a fairly stable pulsatility index (PI) of 2.4-2.6 and resistance index (RI) of 0.91-0.94. On average, 75% of blood ejected by the left ventricle (which represented about 35% of the CCO) passed through the AI to the descending aorta. The fraction of CCO distributed to the upper body, including the brain, was estimated as approximately 13%. CONCLUSION We have established longitudinal reference ranges for fetal AI diameter, blood flow velocities, PI, RI and volume blood flow at 11-20 weeks of gestation. The human fetus appears to direct a relatively small fraction (13%) of its CCO to the upper body, including the brain, during this period of pregnancy.
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Affiliation(s)
- T Vimpeli
- The Central Maternity Unit, City of Tampere, Finland
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Arteaga-Martínez M, Halley-Castillo E, García-Peláez I, Villasis-Keever MA, Aguirre OM, Vizcaino-Alarcón A. Morphometric study of the ventricular segment of the human fetal heart between 13 and 20 weeks' gestation. Fetal Pediatr Pathol 2009; 28:78-94. [PMID: 19241239 DOI: 10.1080/15513810802679449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Our objective was to determine the normal dimensions of the ventricular segment of the human fetal heart between 13 and 20 weeks' gestation. STUDY DESIGN 103 hearts obtained by necropsy were dissected and measurements of different portions of ventricles were determined under stereoscopic magnification. In each ventricle were measured anteroposterior and lateral diameters, inlet and outlet length, and thickness of walls at different levels. Our results showed the cardiac apex was constituted by the left ventricle in 68.9% of the hearts. Both ventricles showed linear growth during this period of fetal development. Ranges in median values of external and internal ventricular measurements were determined. The left ventricular wall was thicker than the right, and the right ventricular cavity was larger. This study provides morphometric reference information concerning the dimensions and growth of both ventricles of the fetal heart, which may be useful in pediatric cardiac surgery and echocardiography.
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Affiliation(s)
- Manuel Arteaga-Martínez
- Department of Anatomy, Faculty of Medicine, Universidad Nacional Autónoma de México, Ciudad Universitaria, México, DF.
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Arráez-Aybar L, Turrero-Nogués A, Marantos-Gamarra D. Embryonic Cardiac Morphometry in Carnegie Stages 15–23, from the Complutense University of Madrid Institute of Embryology Human Embryo Collection. Cells Tissues Organs 2008; 187:211-20. [DOI: 10.1159/000112212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2007] [Indexed: 11/19/2022] Open
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Abstract
The present study was performed on 128 spontaneously aborted human fetuses, aged 15-34 weeks, to compile normative data for ascending aorta dimensions at varying gestational age. Using anatomical dissection, digital-image analysis (system of Leica QWin Pro 16) and statistical analysis (ANOVA, regression analysis) a range of measurements (Length, original and terminal external diameters, volume) for the ascending aorta during gestation was examined. No significant gender differences were found (P > 0.05). The growth curves of the best fit for the plot for each morphometric feature against gestational age were generated. Both the Length and external diameters of the ascending aorta were found to increase in a linear fashion throughout gestation. The Length ranged from 2.63 +/- 0.42 to 10.80 +/- 1.49mm, according to the linear function y = -4.678 + 0.4647x +/- 0.8447 (r = 0.95). The original external diameter ranged from 2.02 +/- 0.26 to 6.84 +/- 0.63 mm, according to the linear model y = -2.103 + 0.2684x +/- 0.3958 (r = 0.97). The terminal external diameter ranged from 1.73 +/- 0.20 to 6.29 +/- 0.52 mm, with accordance to the linear function y = -2.354 + 0.2567x +/- 0.3826 (r = 0.97). The ascending aorta volume ranged from 7.56 +/- 2.65 to 370.99 +/- 105.42 mm3, according to the quadratic function y = 373.1 - 43.38x + 1.30x(2) +/- 24.51 (R2 = 0.89). The growth curves generated from my data might be useful as a reference for fetal echocardiographers in the detection of some congenital cardiovascular abnormalities.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, The Ludwig Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Karłowicza 24 Street, 85-092 Bydgoszcz, Poland.
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van den Wijngaard JPHM, Westerhof BE, Faber DJ, Ramsay MM, Westerhof N, van Gemert MJC. Abnormal arterial flows by a distributed model of the fetal circulation. Am J Physiol Regul Integr Comp Physiol 2006; 291:R1222-33. [PMID: 16778066 DOI: 10.1152/ajpregu.00212.2006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Modeling the propagation of blood pressure and flow along the fetoplacental arterial tree may improve interpretation of abnormal flow velocity waveforms in fetuses. The current models, however, either do not include a wide range of gestational ages or do not account for variation in anatomical, vascular, or rheological parameters. We developed a mathematical model of the pulsating fetoumbilical arterial circulation using Womersley's oscillatory flow theory and viscoelastic arterial wall properties. Arterial flow waves are calculated at different arterial locations from which the pulsatility index (PI) can be determined. We varied blood viscosity, placental and brain resistances, placental compliance, heart rate, stiffness of the arterial wall, and length of the umbilical arteries. The PI increases in the umbilical artery and decreases in the cerebral arteries, as a result of increasing placental resistance or decreasing brain resistance. Both changes in resistance decrease the flow through the placenta. An increased arterial stiffness increases the PIs in the entire fetoplacental circulation. Blood viscosity and peripheral bed compliance have limited influence on the flow profiles. Bradycardia and tachycardia increase and decrease the PI in all arteries, respectively. Umbilical arterial length has limited influence on the PI but affects the mean arterial pressure at the placental cord insertion. The model may improve the interpretation of arterial flow pulsations and thus may advance both the understanding of pathophysiological processes and clinical management.
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Affiliation(s)
- Jeroen P H M van den Wijngaard
- Laser Center and Department of Obstetrics and Gynecology, BMEYE Cardiovascular Monitoring Company, University of Amsterdam, The Netherlands
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Current awareness in prenatal diagnosis. Prenat Diagn 2005. [DOI: 10.1002/pd.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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