Quantitative assessment of circulatory changes in the fetal aortic isthmus during progressive increase of resistance to umbilical blood flow.

BACKGROUNDThis study investigated the effects of impairment to placental flow on flow patterns through the aortic isthmus because in the fetus, this vascular segment is the link between the parallel vascular systems perfused by the left and right ventricles.METHODS AND RESULTSA progressive increase in resistance to blood flow through the placenta was created in seven exteriorized fetal lambs by mechanical umbilical vein compression. Blood flows were measured in the ascending aorta, pulmonary artery, aortic isthmus, and umbilical artery at baseline and at each compression level. The severity of the levels of compression was determined by changes in the flow profile through the umbilical artery. An increase in placental resistance causing a fall in umbilical blood flow of approximately 50% was associated with a retrograde diastolic flow through the aortic isthmus even though the diastolic flow through the umbilical artery remained forward. Because of the systolic predominance, however, the net flow in the i...