Pulmonary Vascular Regulation in the Fetal and Transitional Lung

Hannah Holmes; Brahmdeep S Saini; Olivia J Moir; Jack R T Darby; Janna L Morrison; Liqun Sun; Mike Seed

doi:10.1016/j.clp.2023.11.003

Pulmonary Vascular Regulation in the Fetal and Transitional Lung

Clin Perinatol. 2024 Mar;51(1):1-19. doi: 10.1016/j.clp.2023.11.003. Epub 2023 Dec 7.

Authors

Hannah Holmes¹, Brahmdeep S Saini¹, Olivia J Moir¹, Jack R T Darby², Janna L Morrison³, Liqun Sun¹, Mike Seed⁴

Affiliations

¹ Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada.
² Early Origins of Adult Health Research Group, University of South Australia, Adelaide, South Australia, 5001, Australia.
³ Early Origins of Adult Health Research Group, University of South Australia, Adelaide, South Australia, 5001, Australia; Department of Physiology, Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada; Translational Medicine Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.
⁴ Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada; Translational Medicine Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada; Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada. Electronic address: mike.seed@sickkids.ca.

PMID: 38325936
DOI: 10.1016/j.clp.2023.11.003

Abstract

Fetal lungs have fewer and smaller arteries with higher pulmonary vascular resistance (PVR) than a newborn. As gestation advances, the pulmonary circulation becomes more sensitive to changes in pulmonary arterial oxygen tension, which prepares them for the dramatic drop in PVR and increase in pulmonary blood flow (PBF) that occur when the baby takes its first few breaths of air, thus driving the transition from fetal to postnatal circulation. Dynamic and intricate regulatory mechanisms control PBF throughout development and are essential in supporting gas exchange after birth. Understanding these concepts is crucial given the role the pulmonary vasculature plays in the development of complications with transition, such as in the setting of persistent pulmonary hypertension of the newborn and congenital heart disease. An improved understanding of pulmonary vascular regulation may reveal opportunities for better clinical management.

Keywords: Fetal lung; Pulmonary blood flow; Pulmonary circulation; Pulmonary vascular tone; Pulmonary vasculature; Regulatory factors; Transitional lung; Vascular development.

Publication types

Review

MeSH terms

Female
Fetus* / physiology
Humans
Infant, Newborn
Lung*
Pregnancy
Prenatal Care
Pulmonary Circulation / physiology
Vascular Resistance / physiology