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Onohara D, Hagen M, Louey S, Giraud G, Jonker S, Padala M. Chronic in utero mitral inflow obstruction unloads left ventricular volume in a novel late gestation fetal lamb model. JTCVS OPEN 2023; 16:698-707. [PMID: 38204723 PMCID: PMC10775114 DOI: 10.1016/j.xjon.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 01/12/2024]
Abstract
Objective The in utero no flow/no grow hypothesis postulates that reduced inflow of blood into the left ventricle due to a stenotic mitral valve could lead to ventricular hypoplasia and hypoplastic left heart syndrome. This has been demonstrated in chick embryos, but less so in large animals. We investigated the impact of mitral obstruction on left and right ventricular growth in fetal lambs. Methods Twelve pregnant ewes, most bearing twins, were instrumented at 119 ± 1 days gestational age. Carotid artery and jugular vein catheters, an ascending aorta flow probe, and a left atrial deflated balloon catheter were implanted into 1 fetus (left atrial balloon group), and the twin remained an uninstrumented control. The balloon was inflated gradually over 8 days until net antegrade aortic flow was eliminated. Fetal transesophageal echocardiography was performed at the time of surgery and just before termination in both groups. Results Terminal fetal body weights were comparable between groups. Terminal heart/body weight ratio was higher in left atrial balloon group fetuses (6.9 ± 0.8 g/kg) compared with controls (5.9 ± 0.6 g, P = .0126). The left ventricular/right ventricular weight ratio was 24% (P = .0077) lower in left atrial balloon group fetuses than in controls. Left ventricular/heart weight (0.24 ± 0.04 g/g vs 0.30 ± 0.04 g/g, P = .0009), left ventricular end-diastolic volume (2.3 ± 0.7 mL vs 7.1 ± 0.8 mL; P = .0012), and left ventricular end-systolic volume (1.01 mL [0.95-1.95 mL] vs 3.38 mL [3.28-3.57 mL], P = .0042) were lower in left atrial balloon group fetuses compared with controls. Right ventricular weight (g/kg), right ventricular end-diastolic volume, and right ventricular end-systolic volume were similar between groups. Conclusions In this late-gestation fetal lamb model, in utero obstruction of mitral inflow slowed left ventricular growth and caused right ventricular remodeling.
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Affiliation(s)
- Daisuke Onohara
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, Ga
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Matthew Hagen
- Center for Development Health, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Samantha Louey
- Center for Development Health, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - George Giraud
- Center for Development Health, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
- Department of Cardiology, Portland Veterans Affairs Medical Center, Portland, Ore
| | - Sonnet Jonker
- Center for Development Health, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Muralidhar Padala
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, Ga
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
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Hagen MW, Louey S, Alaniz SM, Belcik T, Muller MM, Brown L, Lindner JR, Jonker SS. Changes in microvascular perfusion of heart and skeletal muscle in sheep around the time of birth. Exp Physiol 2023; 108:135-145. [PMID: 36420621 PMCID: PMC9805518 DOI: 10.1113/ep090809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022]
Abstract
NEW FINDINGS What is the central question of this study? How does the microvascular perfusion of striated muscle change during the dynamic developmental period between the late gestation fetus and early neonate? What is the main finding and its importance? In both myocardium and skeletal muscle, perfusion of striated muscle is significantly reduced in the neonate compared to the late term fetus, but flow reserve is unchanged. The results suggest striated muscle capillary networks grow more slowly relative to the myofibres they nourish during the perinatal period. ABSTRACT Microvascular perfusion of striated muscle is an important determinant of health throughout life. Birth is a transition with profound effects on the growth and function of striated muscle, but the regulation of microvascular perfusion around this transition is poorly understood. We used contrast-enhanced ultrasound perfusion imaging (CEUS) to study the perfusion of left ventricular myocardium and hindlimb biceps femoris, which are populations of muscle with different degrees of change in pre- to postnatal workloads and different capacities for postnatal proliferative growth. We studied separate groups of lambs in late gestation (135 days' gestational age; 92% of term) and shortly after birth (5 days' postnatal age). We used CEUS to quantify baseline perfusion, perfusion during hyperaemia induced by adenosine infusion (myocardium) or electrically stimulated unloaded exercise (skeletal muscle), flow reserve and oxygen delivery. We found heart-to-body weight ratio was greater in neonates than fetuses. Microvascular volume and overall perfusion were lower in neonates than fetuses in both muscle groups at baseline and with hyperaemia. Flux rate differed with muscle group, with myocardial flux being faster in neonates than fetuses, but skeletal muscle flux being slower. Oxygen delivery to skeletal muscle at baseline was lower in neonates than fetuses, but was not significantly different in myocardium. Flow reserve was not different between ages. Given the significant somatic growth, and the transition from hyperplastic to hypertrophic myocyte growth occurring in the perinatal period, we postulate that the primary driver of lower neonatal striated muscle perfusion is faster growth of myofibres than their associated capillary networks.
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Affiliation(s)
- Matthew W. Hagen
- Center for Developmental HealthOregon Health & Science UniversityPortlandORUSA
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
| | - Samantha Louey
- Center for Developmental HealthOregon Health & Science UniversityPortlandORUSA
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
| | - Sarah M. Alaniz
- Center for Developmental HealthOregon Health & Science UniversityPortlandORUSA
| | - Todd Belcik
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
| | - Matthew M. Muller
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
| | - Laura Brown
- Department of PediatricsUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Jonathan R. Lindner
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVAUSA
| | - Sonnet S. Jonker
- Center for Developmental HealthOregon Health & Science UniversityPortlandORUSA
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
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Hagen MW, Louey S, Alaniz SM, Brown L, Lindner JR, Jonker SS. Coronary conductance in the normal development of sheep during the perinatal period. PHYSICS REPORTS-REVIEW SECTION OF PHYSICS LETTERS 2022; 10:e15523. [PMID: 36461657 PMCID: PMC9718948 DOI: 10.14814/phy2.15523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/04/2022]
Abstract
Birth is associated with substantial shifts in cardiovascular physiology. Little is known about coronary vascular adaptations during this period. We used fetal and neonatal lambs to measure coronary function at late gestation (92% of term) and shortly after birth (5-6 days postnatal age). In each animal we measured unanesthetized myocardial perfusion and oxygen delivery using a circumflex artery flow probe. We used inflatable occluders and adenosine to determine coronary conductance and flow reserve. In a subset of animals, we used myocardial contrast echocardiography (MCE, anesthetized) to assess its utility as a tool for studying changes in regional myocardial perfusion in normal development. Separate age-matched animals were instrumented with aortic and coronary sinus sampling catheters to determine myocardial oxygen extraction (unanesthetized). With an average of 17 days of developmental time separating our neonatal and fetal cohorts we found that heart-to-body weight ratio was significantly greater in neonates than fetuses. In resting animals, we found significant decreases in weight-normalized perfusion of, and oxygen delivery to, neonatal relative to fetal myocardium. Similar results were seen when measuring baseline MCE-derived perfusion. Pressure-flow relationship studies revealed lower baseline and maximal coronary conductance in neonates than fetuses, with similar coronary flow reserve between groups. There was greater oxygen extraction in neonates than fetuses. Combined analysis of oxygen extraction with coronary flow suggested greater oxygen consumption by the fetal than neonatal myocardium. We conclude that, during the immediate perinatal period, cardiac growth outpaces coronary microvascular growth resulting in lower capacity for microvascular perfusion in the early neonate.
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Affiliation(s)
- Matthew W. Hagen
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA,Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
| | - Samantha Louey
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA,Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
| | - Sarah M. Alaniz
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA
| | - Laura Brown
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Jonathan R. Lindner
- Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
| | - Sonnet S. Jonker
- Center for Developmental HealthOregon Health & Science UniversityPortlandOregonUSA,Knight Cardiovascular Institute, Oregon Health & Science UniversityPortlandOregonUSA
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Radhakrishnan A, Pickup LC, Price AM, Law JP, McGee KC, Fabritz L, Senior R, Steeds RP, Ferro CJ, Townend JN. Coronary microvascular dysfunction is associated with degree of anaemia in end-stage renal disease. BMC Cardiovasc Disord 2021; 21:211. [PMID: 33902440 PMCID: PMC8074270 DOI: 10.1186/s12872-021-02025-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. METHODS Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. RESULTS 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012-0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74-0.98, p = 0.022). CONCLUSIONS Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.
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Affiliation(s)
- Ashwin Radhakrishnan
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. .,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
| | - Luke C Pickup
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Anna M Price
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jonathan P Law
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Kirsty C McGee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Larissa Fabritz
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Roxy Senior
- Cardiac Research Unit, Northwick Park Hospital, London, United Kingdom.,Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Richard P Steeds
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Charles J Ferro
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jonathan N Townend
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
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White A, Louey S, Chang EI, Boehmer BH, Goldstrohm D, Jonker SS, Rozance PJ. A 1 week IGF-1 infusion decreases arterial insulin concentrations but increases pancreatic insulin content and islet vascularity in fetal sheep. Physiol Rep 2018; 6:e13840. [PMID: 30175552 PMCID: PMC6119661 DOI: 10.14814/phy2.13840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022] Open
Abstract
Fetal insulin is critical for regulation of growth. Insulin concentrations are partly determined by the amount of β-cells present and their insulin content. Insulin-like growth factor-1 (IGF-1) is a fetal anabolic growth factor which also impacts β-cell mass in models of β-cell injury and diabetes. The extent to which circulating concentrations of IGF-1 impact fetal β-cell mass and pancreatic insulin content is unknown. We hypothesized that an infusion of an IGF-1 analog for 1 week into the late gestation fetal sheep circulation would increase β-cell mass, pancreatic islet size, and pancreatic insulin content. After the 1-week infusion, pancreatic insulin concentrations were 80% higher than control fetuses (P < 0.05), but there were no differences in β-cell area, β-cell mass, or pancreatic vascularity. However, pancreatic islet vascularity was 15% higher in IGF-1 fetuses and pancreatic VEGFA, HGF, IGF1, and IGF2 mRNA expressions were 70-90% higher in IGF-1 fetuses compared to control fetuses (P < 0.05). Plasma oxygen, glucose, and insulin concentrations were 25%, 22%, and 84% lower in IGF-1 fetuses, respectively (P < 0.05). The previously described role for IGF-1 as a β-cell growth factor may be more relevant for local paracrine signaling in the pancreas compared to circulating endocrine signaling.
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Affiliation(s)
- Alicia White
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Denver School of MedicineAuroraColorado
| | - Samantha Louey
- Center for Developmental HealthKnight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregon
| | - Eileen I Chang
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Denver School of MedicineAuroraColorado
- Center for Developmental HealthKnight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregon
| | - Brit H. Boehmer
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Denver School of MedicineAuroraColorado
| | - David Goldstrohm
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Denver School of MedicineAuroraColorado
| | - Sonnet S. Jonker
- Center for Developmental HealthKnight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregon
| | - Paul J. Rozance
- Department of PediatricsPerinatal Research CenterUniversity of Colorado Denver School of MedicineAuroraColorado
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Davis L, Musso J, Soman D, Louey S, Nelson JW, Jonker SS. Role of adenosine signaling in coordinating cardiomyocyte function and coronary vascular growth in chronic fetal anemia. Am J Physiol Regul Integr Comp Physiol 2018; 315:R500-R508. [PMID: 29791204 DOI: 10.1152/ajpregu.00319.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fetal anemia causes rapid and profound changes in cardiac structure and function, stimulating proliferation of the cardiac myocytes, expansion of the coronary vascular tree, and impairing early contraction and relaxation. Although hypoxia-inducible factor-1α is sure to play a role, adenosine, a metabolic byproduct that increases coronary flow and growth, is implicated as a major stimulus for these adaptations. We hypothesized that genes involved in myocardial adenosine signaling would be upregulated in chronically anemic fetuses and that calcium-handling genes would be downregulated. After sterile surgical instrumentation under anesthesia, gestationally timed fetal sheep were made anemic by isovolumetric hemorrhage for 1 wk (16% vs. 35% hematocrit). At 87% of gestation, necropsy was performed to collect heart tissue for PCR and immunohistochemical analysis. Anemia increased mRNA expression levels of adenosine receptors ADORA 1, ADORA2A, and ADORA2B in the left and right ventricles (adenosine receptor ADORA3 was unchanged). In both ventricles, anemia also increased expression of ectonucleoside triphosphate diphosphohydrolase 1 and ecto-5'-nucleotidase. The genes for both equilibrative nucleoside transporters 1 and 2 were expressed more abundantly in the anemic right ventricle but were not different in the left ventricle. Neither adenosine deaminase nor adenosine kinase cardiac levels were significantly changed by chronic fetal anemia. Chronic fetal anemia did not significantly change cardiac mRNA expression levels of the voltage-dependent L-type calcium channel, ryanodine receptor 1, sodium-calcium exchanger, sarcoplasmic/endoplasmic reticulum calcium transporting ATPase 2, phospholamban, or cardiac calsequestrin. These data support local metabolic integration of vascular and myocyte function through adenosine signaling in the anemic fetal heart.
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Affiliation(s)
- Lowell Davis
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon.,Department of Obstetrics and Gynecology, Oregon Health & Science University , Portland, Oregon
| | - James Musso
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon
| | - Divya Soman
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon.,Knight Cardiovascular Institute, Oregon Health & Science University , Portland, Oregon
| | - Samantha Louey
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon.,Knight Cardiovascular Institute, Oregon Health & Science University , Portland, Oregon
| | - Jonathan W Nelson
- Knight Cardiovascular Institute, Oregon Health & Science University , Portland, Oregon
| | - Sonnet S Jonker
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon.,Knight Cardiovascular Institute, Oregon Health & Science University , Portland, Oregon
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Turan S, Aberdeen GW, Thompson LP. Chronic hypoxia alters maternal uterine and fetal hemodynamics in the full-term pregnant guinea pig. Am J Physiol Regul Integr Comp Physiol 2017; 313:R330-R339. [PMID: 28679680 DOI: 10.1152/ajpregu.00056.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/22/2017] [Accepted: 06/28/2017] [Indexed: 12/17/2022]
Abstract
Placental hypoxia is associated with maternal hypertension, placental insufficiency, and fetal growth restriction. In the pregnant guinea pig, prenatal hypoxia during early gestation inhibits cytotrophoblast invasion of spiral arteries, increases maternal blood pressure, and induces fetal growth restriction. In this study the impact of chronic maternal hypoxia on fetal heart structure was evaluated using four-dimensional echocardiography with spatiotemporal image correlation and tomographic ultrasound, and uterine and umbilical artery resistance/pulsatility indexes and fetal heart function were evaluated using pulsed-wave Doppler ultrasound. Pregnant guinea pigs were exposed to normoxia (n = 7) or hypoxia (10.5% O2, n = 9) at 28-30 days gestation, which was maintained until full term (65 days). At full term, fetal heart structure and outflow tracts were evaluated in the four-chamber view. Fetal heart diastolic function was assessed by E wave-to-A wave diastolic filling ratios (E/A ratios) of both ventricles and systolic function by the myocardial performance index (or Tie) of left ventricles of normoxic (n = 21) and hypoxic (n = 17) fetuses. There were no structural abnormalities in fetal hearts. However, hypoxia induced asymmetric fetal growth restriction and increased the placental/fetal weight compared with normoxic controls. Hypoxia increased Doppler resistance and pulsatility indexes in the uterine, but not umbilical, arteries, had no effect on the Tie index, and increased the E/A ratio in left, but not right, ventricles. Thus, prolonged hypoxia, starting at midgestation, increases uterine artery resistance and generates fetal growth restriction at full term. Furthermore, the enhanced cardiac diastolic filling with no changes in systolic function or umbilical artery resistance suggests that the fetal guinea pig systemic circulation undergoes a compensated, adaptive response to prolonged hypoxia exposure.
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Affiliation(s)
- Sifa Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Graham W Aberdeen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Loren P Thompson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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