Andersons pediatric cardiology 261
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ThePlacentainCongenitalHeart
Disease
DeborahY.Ho,JackRychik
Abstract
Thehumanplacentaisacomplexorganthatdevelopsaroundthesametime
asthefetalcardiovascularsystem.Highlyvascularized,itsharesanumber
ofcommonbiologicfeatureswiththefetalheartandcirculation.Placental
functioninfluencesbothshort-termfetalandneonataloutcomes,aswellas
long-term,life-longadulthealthandwellness,throughthephenomenonof
fetalprogramming.Abnormalitiesanddeficienciesinplacental
functionalityareincreasinglyrecognizedincongenitalheartdisease.
Improvingourunderstandingoftheplacentaincongenitalheartdiseasewill
allowforopportunitiestoimproveoutcomes.
Keywords
Placenta;maternalfetalenvironment;congenitalheartdisease
outcomes;fetalcirculation;fetalcardiovascularphysiology
Introduction
Theplacentaisoneofthemostimportantandleastunderstoodorgansinthe
humanbody.Itisacomplex,highlyorganizedstructurethat—amazingly—can
begrown,discarded,andfullygrownagaininarepetitivemanner.Morethan
justaninterfaceforfetaloxygenationandnutrition,theplacentaisnow
appreciatedtoexertimportantinfluencesthataffecthealthandwell-beingforthe
lifespanoftheindividual.Placentalstructureandfunctioninfluence
organogenesisduringtheearlyvulnerableperiodoffetaldevelopment,atimein
whichcellsandorgansystemsarehighlyplasticandsensitivetotheirbiologic
environment.Theplacentaleavesanimprintinorgandevelopmentthatnotonly
altersthesubstratepresentingatbirthbutalsocanleaveamarkthatinfluences
organfunctionalitylifelong.Thereforeplacentalstructureandfunctionisan
importantsystemtounderstandwithinthecontextofcongenitalheartdisease
(CHD).
ThestudyofprenatalfactorsinfluencingpostnataloutcomesinCHDhasnot
beenextensivelyexploredbutisnowgaininginterest.DavidBarkerwasthefirst
tointroducetheconceptof“fetalprogramming,”orthefetaloriginsofadult
diseasehypothesis.Barkerfirstdescribedthisphenomenoninrelationtothe
findingsofanassociationbetweendiminishedfetalgrowthandlowbirthweight
withincreasedriskoflateradult-onsetcoronaryarterydisease,hypertension,and
diabetes.Subsequently,ahostofothermatureadultconditionshavenowbeen
linkedtoprenataldeficiencies.Theplacentaisthelynchpin.Variationsinthe
processesofplacentaldevelopmentleadtovariationsinthesupplyofnutrients
tothefetusandprogramanumberofkeysystemsthatarelinkedtolaterdisease.
AswelooktooptimizeandimproveoutcomesforindividualswithCHD,it
makessensetoimproveourunderstandingofhowourbiologicsystemsaresetat
theoutsetbeforebirthandhowitmaydifferinthepopulationofindividuals
withCHD.
Thischapterreviewsthedevelopmentofthehumanplacenta,conditionsof
placentaldiseaseasmodelsforprenataldysfunction,andwhatiscurrently
knownconcerningtheplacentaincongenitalheartmalformations.
