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Ana Beatriz DA, Rita MA, Miguel F, Rita GA, Luís GM. Fetal Aortic and Umbilical Doppler Flow Velocity Waveforms in Pregnancy: The Concept of Aortoumbilical Column. Curr Cardiol Rev 2023; 20:CCR-EPUB-135087. [PMID: 38441054 PMCID: PMC11071678 DOI: 10.2174/011573403x255256230919061018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 03/06/2024] Open
Abstract
Low impedance within the uteroplacental circulation is crucial for fetal development. Flow velocity waveforms (FVW) have been established for the aortic and umbilical arteries in low-risk pregnancies during the second half of pregnancy, but data regarding early gestation is limited. Both vascular territories exhibit higher impedance patterns in pregnancies complicated by fetal growth restriction (FGR), hypertensive disorders, fetal anemia, and chromosomal abnormalities. Early identification of these complications is critical in obstetric practice, to reduce perinatal morbidity and mortality through prevention and close antenatal surveillance. Available data suggest that aortic and umbilical impedances follow the same variation pattern as pregnancy progresses. This observation implies that both vessels may be considered as a single artery, referred to as the "aortoumbilical column". Our hypothesis posits that changes in the hemodynamic pattern of this column could identify high-risk pregnancies, particularly those complicated by preeclampsia, FGR, intrauterine fetal demise, fetal aneuploidies, and fetal anemia. Understanding vascular embryogenesis and the FVWs of the aortic and umbilical arteries enables comprehension of impedance changes throughout normal pregnancies. The continuous variation in impedance along a single vessel supports our concept of the aortoumbilical column. Deviations from the regular pattern could assist in identifying compromised fetuses during early pregnancy. Further research on normal aortoumbilical column FVW and the development of reference charts is necessary to consider this arterial column as a screening tool in clinical practice.
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Affiliation(s)
- De Almeida Ana Beatriz
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de Santo António, University of Oporto, Oporto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Oporto, Oporto, Portugal
| | - Morais Ana Rita
- Instituto de Ciências Biomédicas Abel Salazar, University of Oporto, Oporto, Portugal
| | - Ferreira Miguel
- Instituto de Ciências Biomédicas Abel Salazar, University of Oporto, Oporto, Portugal
| | - Gaio Ana Rita
- Department of Mathematics, Faculty of Sciences, University of Oporto, Oporto, Portugal
| | - Guedes-Martins Luís
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de Santo António, University of Oporto, Oporto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Oporto, Oporto, Portugal
- Fetal Medicine Centre, Centro Hospitalar Universitário de Santo António, University of Oporto, Oporto, Portugal
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Michel JB. Phylogenic Determinants of Cardiovascular Frailty, Focus on Hemodynamics and Arterial Smooth Muscle Cells. Physiol Rev 2020; 100:1779-1837. [DOI: 10.1152/physrev.00022.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The evolution of the circulatory system from invertebrates to mammals has involved the passage from an open system to a closed in-parallel system via a closed in-series system, accompanying the increasing complexity and efficiency of life’s biological functions. The archaic heart enables pulsatile motion waves of hemolymph in invertebrates, and the in-series circulation in fish occurs with only an endothelium, whereas mural smooth muscle cells appear later. The present review focuses on evolution of the circulatory system. In particular, we address how and why this evolution took place from a closed, flowing, longitudinal conductance at low pressure to a flowing, highly pressurized and bifurcating arterial compartment. However, although arterial pressure was the latest acquired hemodynamic variable, the general teleonomy of the evolution of species is the differentiation of individual organ function, supported by specific fueling allowing and favoring partial metabolic autonomy. This was achieved via the establishment of an active contractile tone in resistance arteries, which permitted the regulation of blood supply to specific organ activities via its localized function-dependent inhibition (active vasodilation). The global resistance to viscous blood flow is the peripheral increase in frictional forces caused by the tonic change in arterial and arteriolar radius, which backscatter as systemic arterial blood pressure. Consequently, the arterial pressure gradient from circulating blood to the adventitial interstitium generates the unidirectional outward radial advective conductance of plasma solutes across the wall of conductance arteries. This hemodynamic evolution was accompanied by important changes in arterial wall structure, supported by smooth muscle cell functional plasticity, including contractility, matrix synthesis and proliferation, endocytosis and phagocytosis, etc. These adaptive phenotypic shifts are due to epigenetic regulation, mainly related to mechanotransduction. These paradigms actively participate in cardio-arterial pathologies such as atheroma, valve disease, heart failure, aneurysms, hypertension, and physiological aging.
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He Y, Gao Q, Han B, Zhu X, Zhu D, Tao J, Chen J, Xu Z. Progesterone suppressed vasoconstriction in human umbilical vein via reducing calcium entry. Steroids 2016; 108:118-25. [PMID: 26875775 DOI: 10.1016/j.steroids.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/29/2016] [Accepted: 02/04/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the actions of progesterone on human umbilical vein (HUV) from normal pregnancies and the possible underlying mechanisms involved. HUV rings were suspended in organ baths and exposed to progesterone followed by phenylephrine (PE) or serotonin (5-HT). Progesterone suppressed PE- or 5-HT-induced vasoconstriction in HUV rings. The inhibitory effect induced by progesterone was not influenced by nitric oxide syntheses inhibitor, prostaglandins syntheses blocker, the integrity of endothelium, selective progesterone receptor or potassium channel antagonists. Further testing showed that progesterone and nifedipine (a blocker for L-type calcium channels) produced similar inhibitory effects on PE-, 5-HT-, Bay-k8644-, KCl-induced vasoconstriction in Krebs solution as well as CaCl2-induced vasoconstriction in Ca(2+)-free Krebs solution. But the inhibitory effect of mibefradil (mibe, a blocker for L-type (CaV1.2) and T-type calcium channels (CaV3.2)) on PE-, 5-HT-induced vasoconstriction was significantly greater than progesterone or nifedipine in Krebs solution. Furthermore, progesterone did not affect the vasoconstriction caused by PE, 5-HT, or caffeine in Ca(2+)-free Krebs solution. In addition, incubation HUV with progesterone did not change CaV1.2 and progesterone receptor (PR) expressions. The results gained demonstrated that progesterone could suppress multiple agonist-induced vasoconstrictions in HUV, mainly due to a reduction of calcium entry through L-type calcium channels, not endothelium-dependent vascular relaxation pathways, potassium channels, or Ca(2+) release from intracellular stores, providing new information important to further understanding the contribution of progesterone in the regulation of the placental-fetal circulation.
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Affiliation(s)
- Yun He
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Qinqin Gao
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Bing Han
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xiaolin Zhu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Di Zhu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Jianying Tao
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Jie Chen
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Zhice Xu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China; Center for Perinatal Biology, Loma Linda University, CA, USA.
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Karasu E, Kayacan N, Sadan G, Dinc B. Different effects of different phosphodiesterase type-5 inhibitors in pre-eclampsia. Pregnancy Hypertens 2011; 1:231-7. [DOI: 10.1016/j.preghy.2011.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/08/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
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Radenković M, Radunović N, Momčilov P, Grbović L. Altered response of human umbilical artery to 5-HT in gestational diabetic pregnancy. Pharmacol Rep 2009; 61:520-8. [DOI: 10.1016/s1734-1140(09)70095-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 05/12/2009] [Indexed: 10/25/2022]
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Pekkan K, Dasi LP, Nourparvar P, Yerneni S, Tobita K, Fogel MA, Keller B, Yoganathan A. In vitro hemodynamic investigation of the embryonic aortic arch at late gestation. J Biomech 2008; 41:1697-706. [PMID: 18466908 PMCID: PMC3805112 DOI: 10.1016/j.jbiomech.2008.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 03/10/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
This study focuses on the dynamic flow through the fetal aortic arch driven by the concurrent action of right and left ventricles. We created a parametric pulsatile computational fluid dynamics (CFD) model of the fetal aortic junction with physiologic vessel geometries. To gain a better biophysical understanding, an in vitro experimental fetal flow loop for flow visualization was constructed for identical CFD conditions. CFD and in vitro experimental results were comparable. Swirling flow during the acceleration phase of the cardiac cycle and unidirectional flow following mid-deceleration phase were observed in pulmonary arteries (PA), head-neck vessels, and descending aorta. Right-to-left (oxygenated) blood flowed through the ductus arteriosus (DA) posterior relative to the antegrade left ventricular outflow tract (LVOT) stream and resembled jet flow. LVOT and right ventricular outflow tract flow mixing had not completed until approximately 3.5 descending aorta diameters downstream of the DA insertion into the aortic arch. Normal arch model flow patterns were then compared to flow patterns of four common congenital heart malformations that include aortic arch anomalies. Weak oscillatory reversing flow through the DA junction was observed only for the Tetralogy of Fallot configuration. PA and hypoplastic left heart syndrome configurations demonstrated complex, abnormal flow patterns in the PAs and head-neck vessels. Aortic coarctation resulted in large-scale recirculating flow in the aortic arch proximal to the DA. Intravascular flow patterns spatially correlated with abnormal vascular structures consistent with the paradigm that abnormal intravascular flow patterns associated with congenital heart disease influence vascular growth and function.
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Affiliation(s)
- Kerem Pekkan
- Department of Biomedical and Mechanical Engineering, Carnegie Mellon University, PA, USA.
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Gadelha-Costa A, Spara-Gadelha P, Filho FM, Gadelha EB. Hemodynamic changes in the fetal arteries during the second half of pregnancy assessed by Doppler velocimetry. Eur J Obstet Gynecol Reprod Biol 2007; 132:148-53. [PMID: 17194521 DOI: 10.1016/j.ejogrb.2006.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 10/04/2006] [Accepted: 11/13/2006] [Indexed: 11/28/2022]
Abstract
The applicability of Doppler velocimetry has been well established regarding intrauterine growth restriction and fetal hypoxia. This method can also be used to determine fetal anemia and cardiac malformations. The main fetal arteries evaluated by Doppler velocimetry are the middle cerebral artery and the umbilical artery. However, the fetal aorta is responsible for the distribution of blood flow to the upper and lower extremities of the human body and should also be properly valued. In order to characterize abnormalities in the arteries of high-risk fetuses, it is necessary to know the hemodynamic modifications of normal fetuses. On this basis, the authors performed a review of fetal hemodynamics evaluated by Doppler velocimetry in the fetal aorta and middle cerebral and umbilical arteries during the second half of pregnancy. The study of fetal vessels by Doppler velocimetry indirectly evaluates the hemodynamic changes occurring in fetuses at risk. In this respect, we emphasize the changes in Doppler velocimetry occurring in fetal anemia, in restricted intrauterine growth, and in normal fetuses.
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Affiliation(s)
- Antonio Gadelha-Costa
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, São Paulo University, Av. Bandeirantes, 3.900, Monte Alegre, CEP: 14048-900, Ribeirão Preto-São Paulo-Brazil.
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Gadelha Da Costa A, Mauad Filho F, Spara P, Barreto Gadelha E, Vieira Santana Netto P. Fetal hemodynamics evaluated by Doppler velocimetry in the second half of pregnancy. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:1023-30. [PMID: 16085093 DOI: 10.1016/j.ultrasmedbio.2005.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 04/05/2005] [Accepted: 04/14/2005] [Indexed: 05/03/2023]
Abstract
The objective of our study was to assess fetal hemodynamics by Doppler velocimetry during the second half of pregnancy. We carried out a longitudinal study on 33 normal fetuses between the 22nd and 38th weeks of gestation. Doppler velocimetry was performed in the aorta, suprarenal (SRA) and infrarenal (IRA) segments, middle cerebral artery (MCA) and umbilical artery (UA), on the basis of fetal peak systolic velocity (SV), end-diastolic velocity (DV) and resistance index (RI). We used a sample volume of 1 mm, a wall filter of 50 to 100 Hz, a 5 degrees to 19 degrees insonation angle in the MCA and UA, and below 60 degrees in the SRA and IRA. Between the 22nd and 38th weeks of gestation, SV and DV increased in all fetal arteries (p<0.05), but SV decreased in the UA from 52.5 to 46.2 cm/s between the 34th and 38th gestational weeks (p<0.05). The RI was unchanged in the SRA and throughout most of the gestational weeks in the IRA (p>0.05), but decreased from 0.69 to 0.56 in the UA (p<0.05). In the MCA, it decreased from 0.85 to 0.75 between the 26th and 38th gestational weeks (p<0.05). In conclusion, the volume of blood flow in the fetal organs necessary for their development is related to increased SV and DV and to decreased RI. The Doppler velocimetry measurements for normal fetuses could be compared with those for fetuses in high-risk pregnancies.
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Affiliation(s)
- Antonio Gadelha Da Costa
- Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, SP, Brazil. iggadelha@ig
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Acharya G, Wilsgaard T, Berntsen GKR, Maltau JM, Kiserud T. Doppler-derived umbilical artery absolute velocities and their relationship to fetoplacental volume blood flow: a longitudinal study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:444-453. [PMID: 15816007 DOI: 10.1002/uog.1880] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To construct reference ranges for serial measurements of the umbilical artery (UA) absolute blood flow velocities in the second half of pregnancy and to test the hypothesis that significant associations exist between UA velocities and placental volume blood flow assessed from umbilical vein blood flow velocities and diameter. METHODS This was a prospective longitudinal study of the umbilical circulation. UA absolute velocities and umbilical vein blood flow were measured at 4-weekly intervals between 19 and 42 weeks' gestation in 130 low-risk singleton pregnancies. A total of 511 observations were used to construct the reference ranges and assess the association between UA absolute velocities and placental volume flow using multilevel modeling. RESULTS Both UA absolute velocities and placental volume blood flow showed a steady increase throughout the second half of pregnancy. However, the gestational age-related increase in the UA end-diastolic velocity (EDV) was greater than the corresponding increase in the peak systolic velocity (PSV). The time-averaged intensity-weighted mean velocity (TAWMV)/time-averaged maximum velocity (TAMXV) was 0.6 indicating probably not a completely parabolic velocity profile. There was a significant positive association (P < 0.00001) between UA absolute velocities and placental volume blood flow, but this association was modified by the gestational age. The intraobserver coefficients of variation for the UA PSV, EDV, TAMXV and TAWMV and placental volume blood flow were 10.17%, 16.29%, 11.46%, 18.18% and 8.61%, respectively. CONCLUSION We have established new reference ranges for the UA absolute velocities based on longitudinal data. They show a significant association with fetoplacental volume blood flow and may have a clinical value in the assessment of the umbilical circulation.
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Affiliation(s)
- G Acharya
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway.
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Van der Heiden K, Groenendijk BCW, Hierck BP, Hogers B, Koerten HK, Mommaas AM, Gittenberger-de Groot AC, Poelmann RE. Monocilia on chicken embryonic endocardium in low shear stress areas. Dev Dyn 2005; 235:19-28. [PMID: 16145662 DOI: 10.1002/dvdy.20557] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
During cardiovascular development, fluid shear stress patterns change dramatically due to extensive remodeling. This biomechanical force has been shown to drive gene expression in endothelial cells and, consequently, is considered to play a role in cardiovascular development. The mechanism by which endothelial cells sense shear stress is still unidentified. In this study, we postulate that primary cilia function as fluid shear stress sensors of endothelial cells. Such a function already has been attributed to primary cilia on epithelial cells of the adult kidney and of Hensen's node in the embryo where they transduce mechanical signals into an intracellular Ca2+ signaling response. Recently, primary cilia were observed on human umbilical vein endothelial cells. These primary cilia disassembled when subjected to high shear stress levels. Whereas endocardial-endothelial cells have been reported to be more shear responsive than endothelial cells, cilia are not detected, thus far, on endocardial cells. In the present study, we use field emission scanning electron microscopy to show shear stress-related regional differences in cell protrusions within the cardiovasculature of the developing chicken. Furthermore, we identify one of these cell protrusions as a monocilium with monoclonal antibodies against acetylated and detyrosinated alpha-tubulin. The distribution pattern of the monocilia was compared to the chicken embryonic expression pattern of the high shear stress marker Krüppel-like factor-2. We demonstrate the presence of monocilia on endocardial-endothelial cells in areas of low shear stress and postulate that they are immotile primary cilia, which function as fluid shear stress sensors.
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Affiliation(s)
- Kim Van der Heiden
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Abuhamad A. Color and pulsed Doppler in fetal echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:1-9. [PMID: 15229909 DOI: 10.1002/uog.1096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Fernando KL, Mathews VJ, Varner MW, Clark EB. Robust estimation of fetal heart rate variability using Doppler ultrasound. IEEE Trans Biomed Eng 2003; 50:950-7. [PMID: 12892322 DOI: 10.1109/tbme.2003.814528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents a new measure of heart rate variability (HRV) that can be estimated using Doppler ultrasound techniques and is robust to variations in the angle of incidence of the ultrasound beam and the measurement noise. This measure employs the multiple signal characterization (MUSIC) algorithm which is a high-resolution method for estimating the frequencies of sinusoidal signals embedded in white noise from short-duration measurements. We show that the product of the square-root of the estimated signal-to-noise ratio (SNR) and the mean-square error of the frequency estimates is independent of the noise level in the signal. Since varying angles of incidence effectively changes the input SNR, this measure of HRV is robust to the input noise as well as the angle of incidence. This paper includes the results of analyzing synthetic and real Doppler ultrasound data that demonstrates the usefulness of the new measure in HRV analysis.
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Affiliation(s)
- Kumari L Fernando
- Department of Electrical and Computer Engineering, University of Utah, 50 S. Central Campus Dr., Room 3280 MEB, Salt Lake City, UT 84112, USA.
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