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(Circulation. 1996;94:1068-1073.)
© 1996 American Heart Association, Inc.

Articles

Role of the Pulmonary Circulation in the Distribution of Human Fetal Cardiac Output During the Second Half of Pregnancy

Juha Rasanen, MD; Dennis C. Wood, RDMS; Stuart Weiner, MD; Abraham Ludomirski, MD; James C. Huhta, MD

the Sections of Perinatal Cardiology and Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, and the Section of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Temple University Hospital (A.L.), Philadelphia, Pa.

Correspondence to James C. Huhta, MD, Section of Perinatal Cardiology, Department of Obstetrics and Gynecology, Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA 19107.

Background By using Doppler echocardiography, we determined the normal distribution of human fetal combined cardiac output (CCO) from the left and right ventricles. We also established weight-indexed pulmonary and systemic vascular resistances (R_Pi and R_Si, respectively) and changes during the second half of pregnancy.

Methods and Results Blood flows at the aortic and pulmonary valve annuli (LVCO and RVCO, respectively), right and left pulmonary arteries (Q_P), and ductus arteriosus (Q_DA) were calculated in 63 normal fetuses. Foramen ovale blood flow (Q_FO=LVCO-Q_P) was estimated. From 20 to 30 weeks of gestation, the proportion of Q_P of the CCO increased (from 13% to 25%, P<.001), while the proportion of Q_FO decreased (from 34% to 18%, P<.001). After 30 weeks, the proportions of Q_P and Q_FO were unchanged. At 38 weeks, the proportion of RVCO (60%) was higher (P<.05) than that of LVCO (40%). The proportion of Q_DA did not change significantly. The correlation between RVCO calculated from blood flow through the pulmonary valve and from Q_DA and Q_P was good (r=.97, P<.0001). R_Pi (P<.001) decreased from 20 to 30 weeks of gestation. From 30 to 38 weeks, R_Pi increased (P<.0001). R_Si increased (P<.001) from 20 to 38 weeks. The ratio of R_Pi to R_Si decreased (P<.01) from 20 to 30 weeks and later remained unchanged.

Conclusions The human fetal pulmonary circulation has an important role in the distribution of cardiac output.

Key Words: cardiac output • echocardiography • hemodynamics • physiology • ultrasonics

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