Published: Right ventricular remodeling in response to volume overload in fetal sheep

When blood flow into a heart chamber is increased, it causes the chamber to fill more. That distention makes the chamber adapt over time. This paper is about what happens to heart growth in the fetus when blood flow into the right side of the heart is increased. We did that by sewing a passageway between the carotid artery and the jugular vein on one side of the neck. All of the blood from that artery was diverted directly back into the fetal heart.

How a fetus grows in utero determines their risk for heart disease in later life. The fetal heart grows rapidly, in ways that are fundamentally different than how the adult heart grows. It is important to understand how increased filling by blood affects fetal heart growth, because this may alter cardiac risk for life.

Graph showing that atrial natriuretic peptide increased in fetuses with an arterio-venous fistula.
Figure 2 from the publication. Circulating atrial natriuretic peptide (ANP) levels in experimental fetal right carotid artery-jugular vein (AV) fistula. Plasma ANP levels were not different between groups at baseline (day 0) but were 5-fold greater in the AV fistula than the sham group on days 4 and 7. Values are means?±?SE. *P < 0.05 vs. same-day sham group. †P < 0.05 vs. day 0 within group.

Now we know that when filling of the right side of the fetal heart is increased, the heart muscle cells grow larger. This is a different response than when blood pressure is increased in the fetus, which also causes heart muscle cells to make more of themselves and to mature.

The stimulus of increased filling caused a type of fetal cardiac muscle adaptation that we haven’t seen with other stimuli. Knowing how distention affects fetal heart muscle growth will help us interpret how other conditions, such as low oxygen, change fetal development.

Find this paper the American Journal of Physiology and on PubMed.