Fisiologi sirkulasi fetus, bayi, dewasa

dr. Rohmania Setiarini

The Heart: Blood Flow

Deoxygenated blood in from body
Oxygenated blood in lungs Oxygenated blood out to body

Deoxygenated blood out to lungs Atria Contract Ventricles Contract

The Heart: Blood Flow (cont.)

Right Atrium
Tricuspid Valve

Right Ventricle

Pulmonary Valve

Body

Lungs

Aortic Semilunar Valve

Left Ventricle

Bicuspid Valve

Left Atrium

Pulmonary Semilunar Valve

The Heart: Cardiac Cycle

One heartbeat = one cardiac cycle

Atria contract and relax Ventricles contract and relax

Right atrium contracts

Tricuspid valve opens Blood fills right ventricle

Left atrium contracts

Bicuspid valve opens Blood fills left ventricle

Right ventricle contracts

Tricuspid valve closes Pulmonary semilunar valve opens Blood flows into pulmonary artery

Left ventricle contracts

Bicuspid valve closes Aortic semilunar valve opens Blood pushed into aorta

Conducting System of Heart

Blood Vessels: Arteries and Arterioles

Arterioles Strongest of the Small branches of blood vessels arteries Carry blood away Aorta from the heart Takes blood from the Under high pressure heart to the body Vasoconstriction Coronary arteries

Vasodilation

Supply blood to heart muscle

Blood Vessels: Veins and Venules

Blood under no pressure in veins

Does not move very easily Skeletal muscle contractions help move blood Sympathetic nervous system also influences pressure

Venules
Small vessels formed when capillaries merge

Superior and inferior vena cava

Largest veins Carry blood into right atrium

Valves prevent backflow

Blood Vessels: Capillaries

Branches of arterioles Smallest type of blood vessel Connect arterioles to venules

Only about one cell layer thick

Oxygen and nutrients can pass out of a capillary into a body cell

Carbon dioxide and other waste products pass out of a body cell into a capillary

Circulation

Pulmonary circuit
right atrium right ventricle pulmonary artery trunk pulmonary arteries lungs pulmonary veins heart (left atrium)

Systemic circuit
left atrium left ventricle aorta arteries arterioles capillaries venules veins vena cava heart (right atrium)

Blood Flow Through Heart

Systemic and Pulmonary Circulation

FETAL CIRCULATION
By the third month of development, all major blood vessels are present and functioning. Fetus must have blood flow to placenta. Resistance to blood flow is high in lungs.

UMBILICAL CIRCULATION
Pair of umbilical arteries carry deoxygenated blood & wastes to placenta. Umbilical vein carries oxygenated blood and nutrients from the placenta.

THE PLACENTA
Facilitates gas and nutrient exchange between maternal and fetal blood. The blood itself does not mix.

UMBILICAL VEIN TO PORTAL CIRCULATION

Some blood from the umbilical vein enters the portal circulation allowing the liver to process nutrients. The majority of the blood enters the ductus venosus, a shunt which bypasses the liver and puts blood into the hepatic veins.

FORAMEN OVALE
Blood is shunted from right atrium to left atrium, skipping the lungs. More than one-third of blood takes this route. Is a valve with two flaps that prevent back-flow.

DUCTUS ARTERIOUSUS
The blood pumped from the right ventricle enters the pulmonary trunk. Most of this blood is shunted into the aortic arch through the ductus arteriousus.

WHAT HAPPENS AT BIRTH?

The change from fetal to postnatal circulation happens very quickly. Changes are initiated by babys first breath.

Foramen ovale

Ductus arteriousus

Ductus venosus Umbilical arteries Umbilical vein

Closes shortly after birth, fuses completely in first year. Closes soon after birth, becomes ligamentum arteriousum in about 3 months. Ligamentum venosum

Medial umbilical ligaments Ligamentum teres

PROBLEM WITH PERSISTENCE OF FETAL CIRCULATION

Patent (open) ductus arteriosus and patent foramen ovale each characterize about 8% of congenital heart defects. Both cause a mixing of oxygen-rich and oxygen-poor blood; blood reaching tissues not fully oxygenated. Can cause cyanosis. Surgical correction now available, ideally completed around age two. Many of these defects go undetected until child is at least school age.