[Frontiers in Bioscience S2, 891-906, June 1, 2010]

Fetal heart failure

Tiina H. Ojala1,2, Lisa K. Hornberger1

1Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, and Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada, 2Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

TABLE OF CONTENTS

1. Abstract
2. Normal fetal circulation
3. Fetal myocardial maturation
3.1. Fetal myocardial contractility
3.2. Fetal myocardial diastolic function
3.3. Fetal myocardial response to physiological changes
4. Fetal heart failure
4.1. Physiology of fetal heart failure
4.2. Hydrops fetalis
4.3. Etiologies of fetal heart failure
5. Echocardiographic evaluation of fetal heart failure
5.1. Conventional ultrasound modalities
5.2. New Ultrasound Modalities
6. Management of fetal heart failure
7. Ethical considerations
8. Future directions
9. Acknowledgements 10. References

1. ABSTRACT

Clinical fetal heart failure occurs in conditions associated with increasing left and right atrial filling and/or central venous pressures and manifests as right heart failure with the development of pericardial and pleural effusions, ascites and peripheral and placental edema. Fetal heart failure may occur in primary myocardial disease, in presence of the extracardiac pathology impacting the loading conditions of the fetal heart and in conditions associated with secondary myocardial dysfunction including structural heart defects, bradycardia or tachycardia. This review summarizes recent literature of the understanding of the normal fetal circulation and the pathogenic mechanisms responsible for the evolution of fetal heart failure, strategies for fetal and perinatal management of fetal heart failure, and future directions that may lead to novel strategies to treat affected pregnancies and