Hepatic Artery Hemodynamics Suggest Operation of a Buffer Response in the Human Fetus

Ebbing, Cathrine; Rasmussen, Svein; Godfrey, Keith M.; Hanson, Mark A.; Kiserud, Torvid

doi:10.1177/1933719107310307

Cited by 39 publications

(32 citation statements)

References 104 publications

(130 reference statements)

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“…Johnson et al [9] performed intracardiac punctures in human fetuses, and were able to demonstrate an increase in ventricular systolic and end diastolic pressure with advancing gestational age. Animal studies indicate that the cardiac output does not change in relation to body weight throughout gestation, and the demand of increased circulation to various organs and placenta is met by redistribution rather than an increase in cardiac output [10,11]. Nevertheless, changes to cope with the transition towards LV dominance at birth are not answered for.…”

Section: Discussionmentioning

confidence: 99%

Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study

Elmstedt

Ferm-Widlund

Lind

et al. 2012

Cardiovasc Ultrasound

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BackgroundPresent data regarding how the fetal heart works and develops throughout gestation is limited. However, the possibility to analyze the myocardial velocity profile provides new possibilities to gain further knowledge in this area. Thus, the objective of this study was to evaluate human fetal myocardial characteristics and deformation properties using color-coded tissue velocity imaging (TVI).MethodsTVI recordings from 55 healthy fetuses, at 18 to 42 weeks of gestation, were acquired at a frame rate of 201–273 frames/s for offline analysis using software enabling retrieval of the myocardial velocity curve and 2D anatomical information. The measurements were taken from an apical four-chamber view, and the acquired data was correlated using regression analysis.ResultsLeft ventricular length and width increased uniformly with gestational age. Atrioventricular plane displacement and the E’/A’ ratio also increased with gestational age, while a longitudinal shortening was demonstrated.ConclusionsFetal cardiac muscle contractility decreases with gestational age. As numerous fetal- and pregnancy-associated conditions directly influence the pumping function of the fetal heart, we believe that this new insight into the physiology of the human fetal cardiovascular system could contribute to make diagnosis and risk assessment easier and more accurate.

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Section: Discussionmentioning

confidence: 99%

Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study

Elmstedt

Ferm-Widlund

Lind

et al. 2012

Cardiovasc Ultrasound

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“…The HABR seems to operate in each individual under physiological conditions regardless of age. In addition, by establishing a method for measuring fetal hepatic arterial blood velocity, it has been reported that HABR even operates prenatally [21] .…”

Section: Responsementioning

confidence: 99%

Regulation of hepatic blood flow: The hepatic arterial buffer response revisited

Eipel¹

2010

WJG

441

310

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The interest in the liver dates back to ancient times when it was considered to be the seat of life processes. The liver is indeed essential to life, not only due to its complex functions in biosynthesis, metabolism and clearance, but also its dramatic role as the blood volume reservoir. Among parenchymal organs, blood flow to the liver is unique due to the dual supply from the portal vein and the hepatic artery. Knowledge of the mutual communication of both the hepatic artery and the portal vein is essential to understand hepatic physiology and pathophysiology. To distinguish the individual importance of each of these inflows in normal and abnormal states is still a challenging task and the subject of ongoing research. A central mechanism that controls and allows constancy of hepatic blood flow is the hepatic arterial buffer response. The current paper reviews the relevance of this intimate hepatic blood flow regulatory system in health and disease. We exclusively focus on the endogenous interrelationship between the hepatic arterial and portal venous inflow circuits in liver resection and transplantation, as well as inflammatory and chronic liver diseases. We do not consider the hepatic microvascular anatomy, as this has been the subject of another recent review.

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“…The intriguing arterial buffer response of the liver has been shown to operate not only under physiological conditions and prenatally (166), but is also maintained in cirrhotic livers (18,572,670) (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

The Hepatic Microcirculation: Mechanistic Contributions and Therapeutic Targets in Liver Injury and Repair

Vollmar

Menger²

2009

Physiological Reviews

426

368

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The complex functions of the liver in biosynthesis, metabolism, clearance, and host defense are tightly dependent on an adequate microcirculation. To guarantee hepatic homeostasis, this requires not only a sufficient nutritive perfusion and oxygen supply, but also a balanced vasomotor control and an appropriate cell-cell communication. Deteriorations of the hepatic homeostasis, as observed in ischemia/reperfusion, cold preservation and transplantation, septic organ failure, and hepatic resection-induced hyperperfusion, are associated with a high morbidity and mortality. During the last two decades, experimental studies have demonstrated that microcirculatory disorders are determinants for organ failure in these disease states. Disorders include 1) a dysregulation of the vasomotor control with a deterioration of the endothelin-nitric oxide balance, an arterial and sinusoidal constriction, and a shutdown of the microcirculation as well as 2) an overwhelming inflammatory response with microvascular leukocyte accumulation, platelet adherence, and Kupffer cell activation. Within the sequelae of events, proinflammatory mediators, such as reactive oxygen species and tumor necrosis factor-alpha, are the key players, causing the microvascular dysfunction and perfusion failure. This review covers the morphological and functional characterization of the hepatic microcirculation, the mechanistic contributions in surgical disease states, and the therapeutic targets to attenuate tissue injury and organ dysfunction. It also indicates future directions to translate the knowledge achieved from experimental studies into clinical practice. By this, the use of the recently introduced techniques to monitor the hepatic microcirculation in humans, such as near-infrared spectroscopy or orthogonal polarized spectral imaging, may allow an early initiation of treatment, which should benefit the final outcome of these critically ill patients.

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Hepatic Artery Hemodynamics Suggest Operation of a Buffer Response in the Human Fetus

Cited by 39 publications

References 104 publications

Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study

Fetal cardiac muscle contractility decreases with gestational age: a color-coded tissue velocity imaging study

Regulation of hepatic blood flow: The hepatic arterial buffer response revisited

The Hepatic Microcirculation: Mechanistic Contributions and Therapeutic Targets in Liver Injury and Repair

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