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Dr WuMengYu KO 1 Fetal Circulation and CHD

Kate Meng Yu Wu 1972 2018 KO https www drwumengyu com workshop3627 gmail com

Psalm 139 14 I will praise you for I am fearfully and wonderfully made marvelous are your works and that my soul knows right well

Kate 2020 4 2 YouTube 2134 139

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1 ductus venous ductus arteriosus foramen ovale 1 5 1 1

X Rudolph s Pediatrics 22 Core Topics in Congenital Heart Surgery

HbCO2 O2 CO 2 A HbCO2 O2 CO2 B HbO2 HbO2

Congenital heart surgery Fetal circulation postnatal circulation 2 postnatal circulation Fetal Circulation Fetal Circulation postnatal circulation congenital heart disease

Shortcuts I Prenatal Fetal Circulation 1 Structures essential for fetal survival Placenta as oxygenator Dr WuMengYu Lungs collapse and generate a high afterload to RV Shunts Short cuts Ductus venosus Foramen ovale Ductus arteriosus

80 60 internal iliac artery IVC IVC 70 ductus venosus IVC short cut

Shortcuts I Prenatal Fetal Circulation 1 Structures essential for fetal survival Placenta as oxygenator Dr WuMengYu Lungs collapse and generate a high afterload to RV Shunts Short cuts Ductus venosus Foramen ovale Ductus arteriosus

intracardiac right to left shunt ductus arteriosus DA Foramen ovale FO DA 10 90 DA FO FO FO IVC FO SVC IVC 65

Shortcuts An hyperdynamic heart Lower difference of SaO2 across the oxygenator A high oxygen affinity fetal Hb Dr WuMengYu A high level of Hb

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ATP 2 3 2 3 BPG 2 3 BPG HbA HbF HbA HbF HbA 2 3 BPG HbF HbA HbA HbF HbF HbF HbF HbA HbF 6 1 2 2 3 BPG

Prenatal Shunt dependent because of lung collapsed Shortcuts Postnatal Shunt closure because of lung expanded High resistance Low resistance Delivery

postnatal fetal circulation postnatal circulation right to left shunt left toright shunt PGE2

right to left shunt left to right shunt PGE2 PGE2 24 1

Atrial Septum endocardial cushion A primitive atrium Septum Primum Ostium Primum Ostium Secundum Septum Secundum B Foramen Ovale Atrial Septal Defect ASD

A 5 B 7 8

Patent Ductus Arteriosus PGE PGE PGE 15 15 PGDH PGE NSAIDs Indomethacin Ibuprofen PGE

Common Patterns of CHDs Cyanosis Dyspnea or Metabolic acidosis

dyspnea cyanosis metabolic acidosis and shock

Pulmonary Overflow Dyspnea Pulmonary congestion edema Communication between left and right chambers L to R shunt due to pressure gradient Pulmonary hypertension Dr WuMengYu

Dyspnea X Left to Right Shunt Patent ductus arteriosus PDA Eisenmenger syndrome Left to right shunt right to left shunt

Decreased pulmonary vasculature Pulmonary Underflow Cyanosis BT shunt Dr WuMengYu Right heart pulmonary artery under development ASD VSD

Cyanosis Cyanosis X PDA PDA pulmonary atresia with intact interventricular septum transposition of great arteries PDA

PGE1 DA PGE Alprostadil PGE PGE PGE PGE PGE PGE PGE PGE PGE 15 PGE PGE PGE

Blalock Taussing Shunt BTS A stage 1 surgery for CHD with pulmonary underflow An artificial PDA Providing pulmonary flow via an arch branch No need of CPB BTS perfuses lungs with systemic Decreased pulmonary vasculature BT shunt arterial blood pressure and causes an elevation of pulmonary vascular resistance ASD VSD Dr WuMengYu

BTS PDA 1 PDA PDA Blalock Taussig Shunt BT shunt PDA BT shunt BT shunt BT shunt Eisenmenger syndrome BT shunt

SpO2 HR 98 140 BP 70 35 Systemic Underflow Metabolic acidosis Left side obstructive lesions PDA closure may result hypotension and metabolic acidosis Dr WuMengYu Coarctation Differential pulse cyanosis BP 45 25 SpO2 HR 92 140

DA DA Coarctation DA differential cyanosis

Ductal dependent Lesions Right heart under development Pulmonary underflow Cyanosis Left heart under development Systemic underflow Shock Acidosis Non ductal dependent Lesions Communication between the left and right circulations Pulmonary overflow Dyspnea

Take Home Message DA Right heart under development Left heart under development Ductal dependent lesions DA Dyspnea Non ductal dependent lesions

Dr WuMengYu