University of Miami, Miller School of Medicine, Miami, Florida.
Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia.
Curr Opin Cardiol. 2021 Jan;36(1):56-60. doi: 10.1097/HCO.0000000000000816.
There is an increasing recognition that structural abnormalities and functional changes in the placenta can have deleterious effects on the development of the fetal heart. This article reviews the role of the placenta and the potential impact of placental insufficiency on fetuses with congenital heart disease.
The fetal heart and the placenta are directly linked because they develop concurrently with shared regulatory and signaling pathways. Placental disease is more common in pregnancies carrying a fetus with congenital heart disease and the fetal response to placental insufficiency may lead to the postnatal persistence of cardiac remodeling. The mechanisms underlying this placental-fetal axis of interaction potentially include genetic factors, oxidative stress, chronic hypoxia, and/or angiogenic imbalance.
The maternal-placental-fetal circulation is critical to advancing our understanding of congenital heart disease. We must first expand our ability to detect, image, and quantify placental insufficiency and dysfunction in utero. Elucidating the modifiable factors involved in these pathways is an exciting opportunity for future research, which may enable us to improve outcomes in patients with congenital heart disease.
越来越多的人认识到胎盘的结构异常和功能改变可能对胎儿心脏的发育产生有害影响。本文综述了胎盘的作用以及胎盘功能不全对先天性心脏病胎儿的潜在影响。
胎儿心脏和胎盘直接相关，因为它们具有共同的调节和信号通路，因此同步发育。患有先天性心脏病的胎儿妊娠中胎盘疾病更为常见，胎儿对胎盘功能不全的反应可能导致心脏重塑在出生后持续存在。这种胎盘-胎儿轴相互作用的潜在机制可能包括遗传因素、氧化应激、慢性缺氧和/或血管生成失衡。
母体-胎盘-胎儿循环对于深入了解先天性心脏病至关重要。我们必须首先提高我们在子宫内检测、成像和量化胎盘功能不全和功能障碍的能力。阐明这些途径中涉及的可改变因素是未来研究的一个令人兴奋的机会，这可能使我们能够改善先天性心脏病患者的预后。
