In this literature review the authors present the data on morphological and functional characteristics of heart which develop under the influence of acute and chronic hypoxia in the fetus and newborns. The data on the structural changes of hypoxic and ischemic origin in the heart have been summarized. The association between the structural adjustment of the cardiac muscle and the stage of placental chronic insufficiency has been identified. Much attention is paid to the pathogenesis of structural tissue formations of the heart in the underweight fetus and newborn. The problems of cardiac pathomorphology under the syndrome of intrauterine growth retardation, depending on its type are discussed. The authors discussed in detail the basic morphogenetic aspects of cardiogenic disorders that lead to the formation of complex cardiac defects. The data on minor cardiac abnormalities are presented; their morbid anatomy diagnostics has not been practically performed. The results of this reviewing the literature on cardiac pathomorphology emphasize the role of prenatal cardiovascular diseases diagnostics in the prenatal period; they draw the authors´ attention to improving the methods of diagnosing cardiovascular pathology at the perinatal stage. The morphological and functional manifestations of antenatal stress are in the focus of attention. The characteristics of the heterogeneous cardiomyopathies group is given; the difficulties of their clinical and pathologic diagnostics are discussed. The paper may be of interest for practitioners and teachers of higher medical schools.
cardiovascular system, newborns, fetus, hypoxia, intrauterine growth retardation syndrome
Распространённость сердечно-сосудистых заболеваний в России и во всём мире неуклонно растёт. Увеличивается число детей, страдающих функциональными нарушениями сердечно-сосудистой системы, потому проблема ранней диагностики различных изменений сердца и профилактика этих состояний остаётся крайне актуальной. Исследование морфогенеза сердца и становление формы органа на ранних этапах развития является не только теоретической, но и большой практической проблемой. Знание динамики развития органов и их структурных особенностей в различные сроки пренатального периода позволяют врачу скорригиро-вать патологию на этапе её развития [2,13,19].
Кровообращение в единой функциональной системе мать — плацента — плод является ведущим фактором, обеспечивающим нормальное течение беремен-
1. Belozerov YuM. Detskaya kardiologiya. Moscow; 2004. Russian.
2. Belokon´ NA, Kuberger MB. Bolezni serdtsa i sosudov u detey: rukovodstvo dlya vrachey v 2 t. Moscow; 1987. Russian.
3. Gargin VV, Miroshnichenko MS. Morfofunktsio-nal´nye osobennosti serdets u plodov i novorozhdennykh s zaderzhkoy vnutriutrobnogo razvitiya v sroke gestatsii 27-35 nedel´. Perinatologiya i pediatriya. 2010;2:130-2. Russian.
4. Gerasimova NG, Kruglyakov PP, Balashov VP. Morfofunktsional´nye izmeneniya miokarda pri adaptatsii k stressu. Morfologiya. 2009; 136(4):38-42. Russian.
5. Glukhovets NG. Antropometricheskie pokazateli i massa organov ploda pri pozdnem preryvanii beremennos-ti: metodicheskoe posobie. Sankt-Peterburg; 1995. Russian.
6. Gnusaev SF. Sindrom soedinitel´notkannoy dis-plazii. Rossiyskiy sbornik nauchnykh trudov s mezhduna-rodnym uchastiem. Moscow-Tver´-Sankt-Peterburg: OOO №PRE100; 2010. Russian.
7. Bubnova N1, Zhakota DA, Kask LN, Parsegova TS, Prolygina EA. Kardiomiopatii u detey. Arkhiv patolo-gii. 2010;72(6):ll-6. Russian.
8. Kel´manson IA. Otsrochennyy risk kardiovasku-lyarnoy patologii, assotsiirovannoy s maloy massoy tela pri rozhdenii. Ros. vestn. perinatol. i pediatrii. 1999;2:12-8. Russian.
9. Korkushko OV, Lishnevskaya VYu. Sovremennye predstavleniya о sindrome miokardial´noy ishemii. Krovoobig ta gemostaz. 2003;1:8-17. Russian.
10. Luk´yanova IS, Golovchenko OV. Vplivgostro´i ta khronichno´ivnutrishn´outrobno´igipoksh na tsentral´nugemodinamiku ta funktsionarnuaktivnist´miokarda u novonarodzhenikh. Perinatologiya ta pediatriya. 2003;2:9-11. Russian.
11. Markovskiy VD, Gargin VV, Miroshnichenko MS. Patologicheskaya anatomiya serdtsa pri zaderzhke vnutriutrobnogo razvitiya. Khar´kov: Finart; 2010. Russian.
12. Markovskiy VD, Miroshnichenko MS, Pliten´ ON. Patomorfologiya serdtsa plodov i novorozhdennykh pri razlichnykh variantakh zaderzhki vnutriutrobnogo razvitiya. Perinatologiya i pediatriya. 2012;2:75-7. Russian.
13. Abdul-Ogly LV, Indzhikulyan AA, Kagramanyan AK, Strizhel´chik TV. Morfogeneticheskie osobennosti razvitiya serdtsa v embriogeneze. Materialy III Vseukrainskoy nauchnoy morfologicheskoy konferentsii. Dnepropetrovsk: Porogi; 2006. Russian.
14. Yarygin NE, Korablev AV, Nikolaeva TN Myag-kova MA. Morfologicheskie proyavleniya patologii sistemy mikrogemotsirkulyatsii u nedonoshennykh detey. Arkhiv patologii. 1996;58(1):47-51. Russian.
15. Ostropolets SS. Sovremennye aspekty patolo-gii miokarda u detey. Vrachebnaya praktika. 2007;55(1):34-41. Russian.
16. Prakhov AV, Murashko EV Kliniko-kardiograficheskie osobennosti tranzitornoy ishemii miokarda u novorozhdennykh, perenesshikh gipoksiyu. Pediatriya. 1996;1:38-41. Russian.
17. Petrenko VM. Osnovy embriologii. Voprosy razvitiya v anatomii cheloveka. Sankt-Peterburg: SPbGMA, Iz-datel´stvo DEAN; 2004. Russian.
18. Rybakova MG, Kuznetsova IA. Rol´ apoptoza v ishemicheskom povrezhdenii miokarda. Arkhiv patologii. 2005;67(5):23-5. Russian.
19. Sidorov AG. Morfologicheskie osnovy elektri-cheskoy nestabil´nosti miokarda u novorozhdennykh, perenesshikh perinatal´nuyu gipoksiyu. Vestnik aritmologii. 2000;18:57-60. Russian.
20. Filippov ES, Perfil´eva NA. Zaderzhka vnutriu-trobnogo razvitiya ploda: sovremermye aspekty problemy. Sibirskiy meditsinskiy zhurnal. 2007;69(2):56-61. Russian.
21. Khomich MM, Leonova IA, Dubova TP. Neonat-al´noe porazhenie miokarda. Arkhiv patologii. 2010;72(60):91-4. Russian.
22. Shatorna VF. Vplivteratogennikhchinnikiv na khidrann´ogokardiogenezuzarodka shchura. Tavricheskiy mediko-biologicheskiy vestnik. 2008;3:96-8. Russian.
23. Cecconi M, Johnston E, Rhodes A. What role does the right side of the heart play in circulation. Critical care. 2006;10(3):5-9.
24. Jouk PS, Usson Y. Three-dimensional cartography of the pattern of the myofibres in the second trimester fetal human heart. Anatomy and embryology. 2000;202(4):103-18.
25. Matturri L, Ottaviani G, Ramos SG, Rossi L. Sudden infant death syndrome (SIDS): a study of cardiac conduction system. Cardiovascular pathology. 2000;9(3):137-145.
26. Lima JA, Guzman PA, Yin FC, Brawley RK, Humphrey L, Traill T A, Lima SD, Marino P, Weisfeldt ML, Weiss JL. Septal geometry in the unloaded living human heart. Circulation. 1986;74(3):463-8.
