Hemodynamic analysis of Hyrtl anastomosis in human placenta

1 Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv; 2 Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv; and 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Submitted 12 June 2006 ; accepted in final form 5 October 2006 The Hyrtl anastomosis is a common connection between the umbilical arteries near the cord insertion in most human placentas. It has been speculated that it equalizes the blood pressure between the territories supplied by the umbilical arteries. However, its functional role in the regulation and distribution of fetal blood flow to the placenta has not yet been explored. A computational model has been developed for quantitative analysis of hemodynamic characteristic of the Hyrtl anastomosis in cases of discordant blood flow in the umbilical arteries. Simulations were performed for cases of either increased placental resistance at the downstream end or reduced arterial blood flow due to some pathologies upstream of one of the arteries. The results indicate that when placental territories of one artery impose increased resistance to fetal blood flow, the Hyrtl anastomosis redistributes the blood flow into the second artery to reduce the large pressure gradients that are developed in the affected artery. When one of the arteries conducts a smaller blood flow into the placenta and a relatively smaller pressure gradient is developed, the Hyrtl anastomosis rebuilds the pressure gradients in the affected artery and redistributes blood flow from the unaffected artery to the affected one to improve placental perfusion. In conclusion, the Hyrtl anastomosis plays the role of either a safety valve or a pressure stabilizer between the umbilical arteries at the placental insertion. umbilical artery; fetal blood circulation; biofluid simulations; discordant blood flow Address for reprint requests and other correspondence: D. Elad, Dept. of Biomedical Engineering, Faculty of Engineering, Tel Aviv Univ., Tel Aviv 69978, Israel (e-mail: elad{at}eng.tau.ac.il )