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heart assumes its normal four-chambered shape by
the end of six weeks of intrauterine life
f etal circulation, the right and left ventricles exist in a parallelcircuit( series circuit of a newborn or adult ) fetus, the placenta - gas and metabolite exchange. Fetal lungs do not provide gas exchange, the pulmonary vessels are vasoconstricted, diverting blood away from the pulmonary circulation Three cardiovascular structures unique to the fetus - maintaining this parallel circulation ductus venosusI( ) foramen ovale ( ) ductus arteriosus ( ) placenta is not as efficient an oxygen exchange organ as the lungs, Oxygenated blood from placenta (po2 about 30-35 mm Hg) to umbilical vein umbilical venous Po2 (the highest level of oxygen provided to the fetus) is only about 30-35 mm Hg. (SPO2 80%) 50% of the umbilical venous blood enters the hepatic circulation rest bypasses the liver and joins the inferior vena cava via the ductus venosus ductus venosus provides a low resistance bypass between the portal vein and the inferior vena cava. Most of the umbilical venous blood shunts through the ductus venosus where it partially mixes with poorly oxygenated inferior vena cava blood (spo2 26%)derived from the lower part of the fetal body.
inferior vena caval blood (spo2 67%) comprising that
from( hepatic veins,umbilical veins and that from lower extremities and kidneys enters the right atrium((spo2 67%) On reaching the right atrium the blood stream is divided into two by the inferior margin of septum secundum-the crista dividens. About one-third of the inferior vena cava blood enters the left atrium, through the foramen ovale, then to left ventricle Left ventricular blood –ejectedinto the ascending aorta((Spo2 62%), supplies predominantly the fetal upper body and brain the rest two-thirds mixes with the venous return from the superior vena cava to enter the right ventricle. .
Fetal superior vena cava blood, which is considerably less
oxygenated (Po2 of 12-14 mm Hg), enters the right atrium and preferentially flows across the tricuspid valve, rather than the foramen ovale, into the right ventricle. From the right ventricle, the blood is ejected into the pulmonary artery pulmonary arterial circulation is vasoconstricted so only approximately 5% of right ventricular outflow enters the lungs.\ The major portion of this blood bypasses the lungs and flows right-to-left through the ductus arteriosus((Spo2 52%) into the descending aorta to perfuse the lower part of the fetal body, including providing flow to the placenta via the 2 umbilical arteries. upper part of the fetal body (including the coronary and cerebral arteries and those to the upper extremities) is perfused exclusively from the left ventricle with blood that has a slightly higher Po2 than the blood perfusing the lower part of the fetal body, which is derived mostly from the right ventricle. Only a small volume of blood from the ascending aorta (10% of fetal cardiac output) flows all the way around the aortic arch (aortic isthmus) to the descending aorta.
The total fetal cardiac output—
the combined output of both the left and right ventricles— is ≈450 mL/kg/min. 65% of descending aortic blood flow returns to the placenta; the remaining 35% perfuses the fetal organs and tissues. right ventricular output is probably closer to 1.3 times left ventricularflow during fetal life the right ventricle is not only pumping against systemic blood pressure but is also performing a greater volume of work than the left ventricle. blood flow is an important determinant of growth of fetal cardiac chambers, valves, and blood vessels. the presence of a narrowing (stenosis) of an upstream structure such as the mitral valve, flow downstream into the left ventricle is limited and left ventricular growth may be compromised, leading to hypoplastic left heart syndrome Similarly, stenosis of a downstream structure such as the aortic valve can similarly disrupt flow into the left ventricle and lead to hypoplastic left-heart syndrome. The main differences between the fetal and postnatal circulation are: (i) presence of placental circulation, which provides gas exchange for the fetus (ii) absence of gas exchange in the collapsed lungs; this results in very little flow of blood to the lungs and thus little pulmonary venous return to left atrium; ( (iii) presence of ductus venosus,joining the portal vein with the inferior vena cava, providing a low resistance bypass for umbilical venous blood to reach the inferiorvenacava (iv) widely openforamen ovale to enable oxygenated blood (through umbilicalveins) to reach the left atrium and ventricle for distribution to the coronaries and thebrain;andlastly( (v) wide open ductus arteriosus to allow right ventricular blood to reach the descending aorta, since lungs are non-functioning Circulatory Adjustments at Birth-Transitional Circulation
