Foramen ovale blood flow and cardiac function after main pulmonary artery occlusion in fetal sheep

Abstract

New Findings What is the central question of this study?At near‐term gestation, foramen ovale blood flow accounts for a significant proportion of fetal left ventricular output. Can the foramen ovale increase its volume blood flow when right ventricular afterload is increased by main pulmonary artery occlusion? What is the main finding and its importance?Foramen ovale volume blood flow increased during main pulmonary artery occlusion. However, this increase was attributable to an increase in fetal heart rate, because left ventricular stroke volume remained unchanged. These findings suggest that the foramen ovale has a limited capacity to increase its volume blood flow. Abstract The foramen ovale (FO) accounts for the majority of fetal left ventricular (LV) output. Increased right ventricular afterload can cause a redistribution of combined cardiac output between the ventricles. To understand the capability of the FO to increase its volume blood flow and thus LV output, we mechanically occluded the main pulmonary artery in seven chronically instrumented near‐term sheep fetuses. We hypothesized that FO volume blood flow and LV output would increase during main pulmonary artery occlusion. Fetal cardiac function and haemodynamics were assessed by pulsed and tissue Doppler at baseline, 15 and 60 min after occlusion of the main pulmonary artery and 15 min after occlusion was released. Fetal ascending aorta and central venous pressures and blood gas values were monitored. Main pulmonary artery occlusion initially increased fetal heart rate (P < 0.05) from [mean (SD)] 158 (7) to 188 (23) beats min−1 and LV cardiac output (P < 0.0001) from 629 (198) to 776 (283) ml min−1. Combined cardiac output fell (P < 0.0001) from 1524 (341) to 720 (273) ml min−1. During main pulmonary artery occlusion, FO volume blood flow increased (P < 0.001) from 507 (181) to 776 (283) ml min−1. This increase was related to fetal tachycardia, because LV stroke volume did not change. Fetal ascending aortic blood pressure remained stable. Central venous pressure was higher (P < 0.05) during the occlusion than after it was released. During the occlusion, fetal pH decreased and PnormalCO2 increased. Left ventricular systolic dysfunction developed while LV diastolic function was preserved. Right ventricular systolic and diastolic function deteriorated after the occlusion. In conclusion, the FO has a limited capacity to increase its volume blood flow at near‐term gestation.

Peripheral chemoreflex activation and cardiac function during hypoxemia in near-term fetal sheep without placental compromise

“…In other words, a drop in the lung volume blood flow would lead to a decrease in the LVCO and an increase in the retrograde component in the aortic isthmus blood flow pattern. We have shown that foramen ovale has a limited capacity to increase its volume blood flow (18,29). These findings suggest that fetal pulmonary blood flow has an important role in the regulation of left ventricular output and hemodynamics in the aortic isthmus.…”

Fetal M-mode echocardiography of atria in normal heart anatomy and no functional abnormalities

“…In this way, we believe a new method for fetal foramen ovale haemodynamic evaluation may be created, instead of using animal models, to study the importance of FO [15].…”

Maternal azithromycin therapy for Ureaplasma parvum intraamniotic infection improves fetal hemodynamics in a nonhuman primate model

“…A reduction in left ventricular preload could then result in the reduced left ventricular cardiac output observed in this study with intra-amniotic Ureaplasma infection. The foramen ovale, which shunts oxygenated blood from the right atrium to the left atrium, bypassing the fetal pulmonary circulation, functions close to its maximum capacity 50,51 so cannot increase left atrial flow in order to compensate for this drop in pulmonary venous return. The finding of decreased mitral valve E/A ratio in the infected group (i.e.…”