Placental abnormalities in congenital heart disease.
Placental abnormalities in congenital heart disease.
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DOI：
10.21037/tp-20-347
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发表时间：
2021-08
影响因子：
2
通讯作者：
Limperopoulos C
中科院分区：
文献类型：
--
作者：
Andescavage NN;Limperopoulos C
先天性心脏病 (CHD) 仍然是婴儿最常见的出生缺陷，严重的 CHD 与显着的发病率和死亡率相关。随着强大且无创的先进胎儿成像技术的出现，越来越明显的是，子宫内冠心病的存在会扰乱正常发育，并导致该人群的终生发病。在健康和高危人群中，宫内影响可能会永久性地改变胎儿的发育，这可能会在以后的生活中表现为复杂的疾病，即所谓的胎儿成人疾病发病（FOAD）现象。胎盘不仅在支持胎儿发育方面发挥着关键作用，而且在适应特定的宫内条件方面也发挥着关键作用。然而，胎盘健康、适应和功能障碍在先心病中的作用尚不清楚。在本文中，我们将回顾有关先心病胎盘健康的现有证据，评估该领域现有的知识差距，并强调有希望的新途径，以更好地了解胎盘功能对胎儿健康的影响。我们将回顾离体人类胎盘研究的证据，这些研究描述了妊娠合并冠心病时异常胎盘的发现，以及人类胎盘的体内评估的证据。虽然胎盘发育的总体临床体内评估相当有限，但我们还将回顾来自先进定量和功能磁共振成像的新证据，这些证据为整个妊娠期间的胎盘结构和功能带来了新的见解。通过提供有关胎盘发育的新信息，我们现在可以更详细地探索母体-胎儿-胎盘之间的联系，并更好地了解可能导致先心病幸存者出现不良后果的多因素机制。
Congenital heart disease (CHD) remains the most common birth defect in infants, and critical CHD is associated with significant rates of morbidity and mortality. With the advent of powerful yet noninvasive advanced fetal imaging, it is becoming increasingly evident that the presence of CHD in utero disrupts typical development and contributes to the lifelong morbidity in this population. Across healthy and high-risk populations, intrauterine influences can permanently alter fetal development that may manifest in complex morbidities later in life, the so-called fetal-onset-of-adult-disease (FOAD) phenomenon. The placenta plays a critical role in not only supporting fetal development, but also by adapting to specific intrauterine conditions. The role of placental health, adaptation and dysfunction, however, in CHD is not well understood. In this article, we will review current evidence relating placental health in CHD, appraise existing knowledge-gaps in the field and highlight promising new avenues to better understand the impact of placental function on fetal well-being. We will review evidence of ex vivo human placental studies that describe abnormal placental findings in pregnancies complicated by CHD, as well evidence for in vivo assessments of the human placenta. While overall clinical in vivo assessments of placental development are rather limited, we will also review emerging evidence from advanced quantitative and functional magnetic resonance imaging that are bringing new insights into placental structure and function throughout gestation. By providing novel information about placental development, we can now explore the maternal-fetal-placental connection in greater detail, and better understand the multi-factorial mechanisms that may contribute to adverse outcomes seen in survivors of CHD.