Department of Pediatric Cardiology, São João Hospital, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
Heart Fail Rev. 2017 Nov;22(6):861-877. doi: 10.1007/s10741-017-9638-z.
Epidemiologic and experimental evidence suggests that adverse stimuli during critical periods in utero permanently alters organ structure and function and may have persistent consequences for the long-term health of the offspring. Fetal hypoxia, maternal malnutrition, or ventricular overloading are among the major adverse conditions that can compromise cardiovascular development in early life. With the heart as a central organ in fetal adaptive mechanisms, a deeper understanding of the fetal cardiovascular physiology and of the echocardiographic tools to assess both normal and stressed pregnancies would give precious information on fetal well-being and hopefully may help in early identification of special risk groups for cardiovascular diseases later in life. Assessment of cardiac function in the fetus represents an additional challenge when comparing to children and adults, requiring advanced training and a critical approach to properly acquire and interpret functional parameters. This review summarizes the basic fetal cardiovascular physiology and the main differences from the mature postnatal circulation, provides an overview of the particularities of echocardiographic evaluation in the fetus, and finally proposes an integrated view of in utero programming of cardiovascular diseases later in life, highlighting priorities for future clinical research.
流行病学和实验证据表明，子宫内关键期的不利刺激会永久性地改变器官结构和功能，并可能对后代的长期健康产生持久影响。胎儿缺氧、母体营养不良或心室超负荷等是主要的不利条件，会损害早期生命中的心血管发育。由于心脏是胎儿适应机制的中心器官，因此深入了解胎儿心血管生理学以及评估正常和应激妊娠的超声心动图工具，将为胎儿健康状况提供宝贵信息，并有望帮助早期识别生命后期心血管疾病的特殊高危人群。与儿童和成人相比，评估胎儿的心脏功能是一个额外的挑战，需要高级培训和批判性的方法来正确获取和解释功能参数。本综述总结了基本的胎儿心血管生理学以及与成熟的产后循环的主要差异，概述了胎儿超声心动图评估的特殊性，并最终提出了胎儿期心血管疾病编程的综合观点，突出了未来临床研究的重点。
