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Lantto J, Erkinaro T, Haapsamo M, Huhta H, Alanne L, Kokki M, Ohtonen P, Bhide A, Acharya G, Räsänen J. Peripheral chemoreflex activation and cardiac function during hypoxemia in near-term fetal sheep without placental compromise. J Appl Physiol (1985) 2021; 131:1486-1495. [PMID: 34590908 DOI: 10.1152/japplphysiol.01111.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A drop in arterial oxygen content activates fetal chemoreflex including an increase in sympathetic activity leading to peripheral vasoconstriction and redistribution of blood flow to protect the brain, myocardium, and adrenal glands. By using a chronically instrumented fetal sheep model with intact placental circulation at near-term gestation, we investigated the relationship between peripheral chemoreflex activation induced by hypoxemia and central hemodynamics. A total of 17 Åland landrace sheep fetuses at 115-128/145 gestational days were instrumented. Carotid artery was catheterized in 10 fetuses and descending aorta in 7 fetuses. After a 4-day recovery, baseline measurements of fetal arterial blood pressures, blood gas values, and fetal cardiovascular hemodynamics by pulsed Doppler ultrasonography were obtained under isoflurane anesthesia. Comparable data to baseline were collected 10 min (acute hypoxemia) and 60 min (prolonged hypoxemia) after maternal hypo-oxygenation to saturation level of 70%-80% was achieved. During prolonged hypoxemia, pH and base excess (BE) were lower and lactate levels were higher in the descending aorta than in the carotid artery. During hypoxemia mean arterial blood pressure (MAP) in the descending aorta increased, whereas in the carotid artery, MAP decreased. In addition, right pulmonary artery pulsatility index values increased, and the diastolic component in the aortic isthmus blood flow velocity waveform became more retrograde, thus decreasing the aortic isthmus antegrade/retrograde blood flow (AoI Net Flow) ratio. Both fetal ventricular cardiac outputs were maintained even during prolonged hypoxemia when significant fetal metabolic acidemia developed. Fetal chemoreflex activation induced by hypoxemia decreased the perfusion pressure in the cerebral circulation. Fetal weight-indexed left ventricular cardiac output (LVCO) or AoI Net Flow ratio did not correlate with a drop in carotid artery blood pressure.NEW & NOTEWORTHY During fetal hypoxemia with intact placental circulation, peripheral chemoreflex was activated, as demonstrated by an increase in the descending aorta blood pressure, pulmonary vasoconstriction, and an increase in retrograde diastolic AoI blood flow, while both ventricular cardiac outputs remained stable. However, perfusion pressure in the cerebral circulation decreased. These changes were seen even during prolonged hypoxemia when significant metabolic acidosis developed. Weight-indexed LVCO or AoI Net Flow ratio did not correlate with a drop in carotid artery blood pressure.
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Affiliation(s)
- Juulia Lantto
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Tiina Erkinaro
- Department of Anesthesiology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mervi Haapsamo
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Heikki Huhta
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Leena Alanne
- Department of Obstetrics and Gynecology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.,Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine Kuopio, Kuopio, Finland
| | - Merja Kokki
- Department of Anesthesiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Amarnath Bhide
- Department of Obstetrics and Gynecology, St. George's Hospital, London, United Kingdom.,Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ganesh Acharya
- Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Juha Räsänen
- Department of Obstetrics and Gynecology, Fetal Medicine Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Alanne L, Bhide A, Lantto J, Huhta H, Kokki M, Haapsamo M, Acharya G, Räsänen J. Nifedipine disturbs fetal cardiac function during hypoxemia in a chronic sheep model at near term gestation. Am J Obstet Gynecol 2021; 225:544.e1-544.e9. [PMID: 33887239 DOI: 10.1016/j.ajog.2021.04.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nifedipine is a widely used drug in pregnancies complicated by maternal hypertensive disorders that can be associated with placental insufficiency and fetal hypoxemia. The evidence regarding fetal myocardial responses to nifedipine in hypoxemia is limited. OBJECTIVE We hypothesized that nifedipine would not impair fetal sheep cardiac function under hypoxemic environment. In particular, we investigated the effects of nifedipine on fetal ventricular functional parameters and cardiac output. STUDY DESIGN A total of 21 chronically instrumented fetal sheep at 122 to 134 gestational days (term, 145 days) were included in this study. Fetal cardiac function was evaluated by measuring global longitudinal strain, indices describing ventricular systolic and diastolic function, and cardiac outputs using two-dimensional speckle tracking and tissue and spectral pulsed-wave Doppler echocardiography. Fetal carotid artery blood pressure and blood gas values were invasively monitored. After baseline data collection, fetal hypoxemia was induced by maternal hyperoxygenation. After hypoxemia phase data collection, 9 fetuses received nifedipine infusion, and 12 fetuses received saline infusion. Data were collected 30 and 120 minutes after the infusion was started. After 120 minutes of data collection, maternal and fetal oxygenation were normalized, and normoxemia phase data were collected, while infusion was continued. RESULTS Hypoxemia decreased fetal carotid artery mean arterial pressure from 40 (8) mm Hg to 35 (8) mm Hg (P<.007), and left ventricular global longitudinal strain showed less deformation than at baseline (P=.001). Under hypoxemia, nifedipine caused a reduction in right ventricular global longitudinal strain (P<.05), a decrease in right ventricular isovolumic relaxation velocity and its deceleration (P<.01) indicating diastolic dysfunction, and a drop in right ventricular cardiac output (P<.05). Nifedipine did not alter fetal left ventricular functional parameters or cardiac output. When normoxemia was restored, fetal right ventricular functional parameters and cardiac output returned to baseline level. CONCLUSION In hypoxemic fetus, nifedipine impaired right ventricular function and reduced its cardiac output. The detrimental effects of nifedipine on fetal right ventricular function were abolished, when normoxemia was restored. Our findings suggest that in a hypoxemic environment nifedipine triggers detrimental effects on fetal right ventricular function.
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Affiliation(s)
- Leena Alanne
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland; Faculty of Health Sciences, Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Amarnath Bhide
- Department of Obstetrics and Gynecology, St. George's Hospital, London, United Kingdom; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Juulia Lantto
- Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki Huhta
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Kokki
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Mervi Haapsamo
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ganesh Acharya
- Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Juha Räsänen
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Alanne L, Bhide A, Hoffren J, Lantto J, Huhta H, Kokki M, Haapsamo M, Acharya G, Räsänen J. Effects of nifedipine and sildenafil on placental hemodynamics and gas exchange during fetal hypoxemia in a chronic sheep model. Placenta 2019; 90:103-108. [PMID: 32056540 DOI: 10.1016/j.placenta.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We hypothesized that nifedipine and sildenafil would have no detrimental effects on placental hemodynamics and gas exchange under fetal hypoxemia. METHODS In 33 chronically instrumented fetal sheep, placental volume blood flow (QPlac) and umbilical artery (UA) vascular impedance were measured by Doppler ultrasonography. Fetal carotid artery blood pressure and blood gas values were monitored. After baseline data collection, maternal and fetal hypoxemia were induced. Following hypoxemia phase data collection, 12 fetuses received sildenafil and 9 fetuses nifedipine infusion, and 12 fetuses served as controls receiving saline infusion. Data were collected 30 and 120 min after infusion was started. Then maternal oxygenation was normalized and normoxemia phase data were collected, while infusion was continued. RESULTS Hypoxemia significantly decreased fetal pO2 and blood pressure. In the sildenafil group at 30- and 120-min hypoxemia + infusion phases, fetal blood pressure and QPlac were significantly lower and pCO2 higher than at baseline without returning to baseline level at normoxemia + infusion phase. In hypoxemia, nifedipine did not affect fetal blood pressure or placental hemodynamics. Both in the sildenafil and nifedipine groups, fetal pO2 remained significantly lower at normoxemia + infusion phase than in the control group. Umbilical artery vascular impedance did not change during the experiment. DISCUSSION In fetal hypoxemia, sildenafil had detrimental effects on placental hemodynamics that disturbed placental gas exchange. Nifedipine did not alter placental hemodynamics in hypoxemia but disturbed placental gas exchange upon returning to normoxemia. Umbilical artery vascular impedance did not reflect alterations in placental hemodynamics.
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Affiliation(s)
- Leena Alanne
- Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Amarnath Bhide
- Department of Obstetrics and Gynecology, St. George's Hospital, London, United Kingdom; Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Jonna Hoffren
- Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Juulia Lantto
- Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki Huhta
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Merja Kokki
- Department of Anesthesiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mervi Haapsamo
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - Ganesh Acharya
- Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Clinical Science, Intervention & Technology, Karolinska Institute and Center for Fetal Medicine Karolinska University Hospital, Stockholm, Sweden
| | - Juha Räsänen
- Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Lantto J, Erkinaro T, Haapsamo M, Huhta H, Voipio HM, Hohimer AR, Davis LE, Acharya G, Räsänen J. Foramen ovale blood flow and cardiac function after main pulmonary artery occlusion in fetal sheep. Exp Physiol 2019; 104:189-198. [PMID: 30578690 DOI: 10.1113/ep087423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/18/2018] [Indexed: 11/08/2022]
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 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:msub><mml:mi>P</mml:mi> <mml:mrow><mml:mi>C</mml:mi> <mml:msub><mml:mi>O</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> </mml:msub> </mml:math> 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.
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Affiliation(s)
- Juulia Lantto
- Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tiina Erkinaro
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Mervi Haapsamo
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - Heikki Huhta
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Hanna-Marja Voipio
- Laboratory Animal Centre, Experimental Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - A Roger Hohimer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Lowell E Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Science, University of Norway and University Hospital of Northern Norway, Tromsø, Norway.,Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Juha Räsänen
- Department of Obstetrics and Gynecology, Oulu University Hospital and University of Oulu, Oulu, Finland.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.,Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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5
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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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Bhide A, Alanne L, Rasanen J, Huhta H, Junno J, Kokki M, Erkinaro T, Ohtonen P, Haapsamo M, Acharya G. Effect of Sildenafil on Pulmonary Circulation and Cardiovascular Function in Near-Term Fetal Sheep During Hypoxemia. Reprod Sci 2018; 26:337-347. [PMID: 29716434 DOI: 10.1177/1933719118773412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sildenafil is a potential new treatment for placental insufficiency in human pregnancies as it reduces the breakdown of vasodilator nitric oxide. Pulmonary vasodilatation is observed in normoxemic fetuses following sildenafil administration. Placental insufficiency often leads to fetal hypoxemia that can cause pulmonary vasoconstriction and fetal cardiac dysfunction as evidenced by reduced isovolumic myocardial velocities. We tested the hypotheses that sildenafil, when given directly to the hypoxemic fetus, reverses reactive pulmonary vasoconstriction, increases left ventricular cardiac output by increasing pulmonary venous return, and ameliorates hypoxemic myocardial dysfunction. We used an instrumented sheep model. Fetuses were made hypoxemic over a mean (standard deviation) duration of 41.3 (9.5) minutes and then given intravenous sildenafil or saline infusion. Volume blood flow through ductus arteriosus was measured with an ultrasonic transit-time flow probe. Fetal left and right ventricular outputs and lung volume blood flow were calculated, and ventricular function was examined using echocardiography. Lung volume blood flow decreased and the ductus arteriosus volume blood flow increased with hypoxemia. There was a significant reduction in left ventricular and combined cardiac outputs during hypoxemia in both groups. Hypoxemia led to a reduction in myocardial isovolumic velocities, increased ductus venosus pulsatility, and reduced left ventricular myocardial deformation. Direct administration of sildenafil to hypoxemic fetus did not reverse the redistribution of cardiac output. Furthermore, fetal cardiac systolic and diastolic dysfunction was observed during hypoxemia, which was not improved by fetal sildenafil treatment. In conclusion, sildenafil did not improve pulmonary blood flow or cardiac function in hypoxemic sheep fetuses.
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Affiliation(s)
- Amarnath Bhide
- 1 Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Leena Alanne
- 2 Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Juha Rasanen
- 3 Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland.,4 Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Heikki Huhta
- 4 Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Juulia Junno
- 4 Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Merja Kokki
- 5 Department of Anesthesiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tiina Erkinaro
- 6 Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- 7 Department of Statistics, Oulu University Hospital, Oulu, Finland
| | - Mervi Haapsamo
- 8 Department of Obstetrics and Gynecology, Lapland Central Hospital, Finland
| | - Ganesh Acharya
- 1 Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.,9 Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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7
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Huhta H, Junno J, Haapsamo M, Erkinaro T, Ohtonen P, Davis LE, Hohimer AR, Acharya G, Rasanen J. Fetal sheep central haemodynamics and cardiac function during occlusion of the ascending aorta. Exp Physiol 2017; 103:58-67. [DOI: 10.1113/ep086500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Heikki Huhta
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
| | - Juulia Junno
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
| | - Mervi Haapsamo
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
| | - Tiina Erkinaro
- Department of Anesthesiology and Surgery; Oulu University Hospital; Oulu Finland
| | - Pasi Ohtonen
- Division of Operative Care and Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Finland
| | - Lowell E. Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
| | - A. Roger Hohimer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
| | - Ganesh Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Science; University of Norway and University Hospital of Northern Norway; Tromsø Norway
- Department of Clinical Science, Intervention and Technology; Karolinska Institute; Stockholm Sweden
| | - Juha Rasanen
- Department of Obstetrics and Gynecology; University of Oulu; Oulu Finland
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology; Oregon Health & Science University; Portland OR USA
- Department of Obstetrics and Gynecology; Helsinki University Hospital; Helsinki Finland
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8
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Hashima JN, Rogers V, Langley SM, Ashraf M, Sahn DJ, Ohtonen P, Davis LE, Hohimer AR, Rasanen J. Fetal ventricular interactions and wall mechanics during ductus arteriosus occlusion in a sheep model. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1020-1028. [PMID: 25701524 PMCID: PMC4407698 DOI: 10.1016/j.ultrasmedbio.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 06/04/2023]
Abstract
We investigated the effect of fetal sheep ductus arteriosus occlusion (DO) on the distribution of cardiac output and left and right ventricular function by tissue and pulsed Doppler at baseline; after 15 and 60 min of DO induced with a vascular occluder; and 15 min after release of DO. Ductal occlusion decreased fetal pO2. Mean left ventricular output increased (p < 0.001) from 725 to 1013 mL/min, and right ventricular (1185 mL/min vs. 552 mL/min) and systemic (1757 mL/min vs. 1013 mL/min) cardiac outputs fell (p < 0.001) after 15 min of DO, compared with baseline. Pulmonary vascular impedance decreased and volume blood flow increased more than threefold during DO, whereas foramen ovale volume blood flow remained unchanged. Left ventricular systolic function was unaffected, whereas isovolumic relaxation velocity deceleration decreased. Right ventricular functional indices remained unchanged. We conclude that DO increased pulmonary volume blood flow, not foramen ovale volume blood flow. Left ventricular output increased, although not as much as right ventricular output fell, resulting in decreased systemic cardiac output. During DO, left ventricular function exhibited diminished relaxation.
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Affiliation(s)
- Jason N Hashima
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Vanessa Rogers
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephen M Langley
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammed Ashraf
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Sahn
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Pasi Ohtonen
- Department of Anesthesiology and Surgery, Oulu University Hospital, Oulu, Finland
| | - Lowell E Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Roger Hohimer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Juha Rasanen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA; Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
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9
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Junno J, Bruun E, Gutierrez JH, Erkinaro T, Haapsamo M, Acharya G, Räsänen J. Fetal sheep left ventricle is more sensitive than right ventricle to progressively worsening hypoxemia and acidemia. Eur J Obstet Gynecol Reprod Biol 2012; 167:137-41. [PMID: 23266204 DOI: 10.1016/j.ejogrb.2012.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 11/24/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In a sheep model we tested the hypothesis that the fetal left ventricle is less tolerant to worsening acidemia than the right ventricle. STUDY DESIGN At 106-124/145 days of gestation, 12 fetuses were instrumented. After a 4-day recovery, placental vascular resistance was increased by fetal angiotensin (AT) II infusion. After a 2h ATII infusion, to further deteriorate fetal oxygenation, maternal hypoxemia was induced. Fetal cardiac function and hemodynamics were assessed by tissue Doppler imaging (TDI) and pulsed Doppler imaging. Ultrasonography was performed at baseline, at 1 and 2h after the beginning of ATII infusion and during the ATII+hypoxemia phase. RESULTS Fetal pH and pO₂ decreased significantly and progressively during the experiment. Left ventricular TDI-derived isovolumic relaxation velocity (IVRV) was lower during ATII 2h and ATII+hypoxemia phases than at baseline. The IVRV deceleration was significantly less during the ATII+hypoxemia phase than at baseline. Right ventricular IVRV was significantly lower during the ATII+hypoxemia phase than at baseline. IVRV deceleration did not change. Only left ventricular IVRV deceleration correlated with fetal pO₂ (R=0.36, p<0.05). Fetal right and left ventricular cardiac outputs, as well as umbilical artery, aortic isthmus and ductus venosus pulsatility indices remained unchanged during the experiment. CONCLUSION Our results show that signs of cardiac dysfunction develop earlier in the left ventricle than in the right ventricle. The fetal left ventricle seems to be more sensitive to progressively worsening hypoxemia and acidemia than the right ventricle.
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Affiliation(s)
- Juulia Junno
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
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