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By Nicholas S. Assali (Eds.)

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Extra resources for Fetal and Neonatal Disorders

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Elevation of right atrial pressure is usual and is due to significant tricuspid valve incompetence as well as resistance to filling offered by a poorly compliant hypertrophied right ventricle. This is associated with a massively dilated and hypertensive right atrium which results in a right to left shunt across the foramen ovale with subsequent hypoxemia. T e m p o r a r y improvement in arterial P02 m a y result from 1. DISORDERS OF CIRCULATION 47 left to right shunt across the ductus b u t generally this is inadequate and in most babies the ductus closes within a few days.

T h e carotid and subclavian arteries are perfused in a retrograde manner from the ductus arteriosus. Coronary arterial blood m a y also be derived from the ductus arteriosus, which provides the conduit to the hypoplastic ascending aorta. Small volumes of blood m a y enter the ascending aorta from the left ventricle if there is a minute opening 38 SAMUEL KAPLAN AND NICHOLAS S. ASSALI in the aortic valve. P u l m o n a r y arterial hypertension is usual since the right ventricle which perfuses the lungs via large pulmonary arteries is also ejecting blood against systemic vascular resistance.

Lü χ ι- erx < er ÜJ er J— C M cto ' cri ZD AL ART. < CT ζ CAL. VEI • 20- < QC CO RA TE ο ο ο _ι CO IAL PRE er ο ο EN CO Ο AL ART MATERNAL cr ο ÜJ ü_ CVJ > CD ZD ίΠΜΓ -20Η 2 Ο -40H < 2 -60- FIG. 14. Effects of i n t r a v e n o u s i n j e c t i o n s of hydralazine (Apresoline) i n t o t h e e w e o n maternal and fetal circulation and o x y g e n a t i o n . A d m i n i s t r a t i o n of 15 m g decreases maternal arterial pressure and uterine b l o o d flow m a r k e d l y .

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