Cardiovascular System - Ductus Venosus

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Introduction

Fetal ductus venosus cartoon
Fetal Ductus Venosus
Fetal ductus venosus cartoon
Fetal circulation

The ductus venosus describes the vitelline blood vessel lying within the liver that connects (shunts) the portal and placental (umbilical) veins to the inferior vena cava and also acts to protect the fetus from placental over-circulation. Blood flow within the ductus venosus is sensitive to changes in placental venous pressure, blood viscosity, and the regulation of ductus venosus diameter.

During the second and third trimester, the mean fraction of placental blood shunted through the ductus venosus reduces from 30% to 20%, suggesting a fetal liver priority of circulation.. [1]

Postnatally this shunt functionally closes (93% of infants at 2 weeks) then structurally closes and degenerates to form it the ligamentum venosum. A comparison at day 3 of postnatal shunt closures; 94% of infants have a closed ductus arteriosus, while only 12% had a closed ductus venosus.[2]


Abnormalities include an absence or patently. Absence can cause hydrops fetalis and the umbilical vein then drains directly into the inferior vena cava or right atrium. A patent or persistent ductus venosus describes the postnatal failure of this vessel to close.


See also the related pages foramen ovale, ductus arteriosus, Arterial Development, Venous Development, Placental Villi Blood Vessels and coronary circulation.


Cardiovascular Links: cardiovascular | Heart Tutorial | Lecture - Early Vascular | Lecture - Heart | Movies | 2016 Cardiac Review | heart | coronary circulation | heart valve | heart rate | Circulation | blood | blood vessel | blood vessel histology | heart histology | Lymphatic | ductus venosus | spleen | Stage 22 | cardiovascular abnormalities | OMIM | 2012 ECHO Meeting | Category:Cardiovascular
Historic Embryology - Cardiovascular 
1902 Vena cava inferior | 1905 Brain Blood Vessels | 1909 Cervical Veins | 1909 Dorsal aorta and umbilical veins | 1912 Heart | 1912 Human Heart | 1914 Earliest Blood-Vessels | 1915 Congenital Cardiac Disease | 1915 Dura Venous Sinuses | 1916 Blood cell origin | 1916 Pars Membranacea Septi | 1919 Lower Limb Arteries | 1921 Human Brain Vascular | 1921 Spleen | 1922 Aortic-Arch System | 1922 Pig Forelimb Arteries | 1922 Chicken Pulmonary | 1923 Head Subcutaneous Plexus | 1923 Ductus Venosus | 1925 Venous Development | 1927 Stage 11 Heart | 1928 Heart Blood Flow | 1935 Aorta | 1935 Venous valves | 1938 Pars Membranacea Septi | 1938 Foramen Ovale | 1939 Atrio-Ventricular Valves | 1940 Vena cava inferior | 1940 Early Hematopoiesis | 1941 Blood Formation | 1942 Truncus and Conus Partitioning | Ziegler Heart Models | 1951 Heart Movie | 1954 Week 9 Heart | 1957 Cranial venous system | 1959 Brain Arterial Anastomoses | Historic Embryology Papers | 2012 ECHO Meeting | 2016 Cardiac Review | Historic Disclaimer
Historic - Ductus Venosus: 1923 Ductus Venosus

Some Recent Findings

  • Patent Ductus Venosus and Congenital Heart Disease: A Case Report and Review[3] "In utero, the ductus venosus connects the left portal vein to the inferior vena cava, allowing a portion of the venous blood to bypass the liver and return to the heart. After birth, the ductus venosus closes due to changes in intracardiac pressures and a decrease in endogenous prostaglandins. Failure of the ductus venosus to close may result in galactosemia, hypoxemia, encephalopathy with hyperammonia, and hepatic dysfunction. We report an infant with complex congenital heart disease (CHD) who developed coagulopathy and hyperammonia during the preoperative period secondary to patent ductus venosus (PDV). Previous reports of PDV in CHD are presented, its etiology and clinical consequences reviewed, and options for therapeutic treatment discussed."
  • Normal variants of ductus venosus spectral Doppler flow patterns in normal pregnancies[4] "Ductus venosus (DV) Doppler examinations in pregnancy have a widespread use for several important indications and play a crucial role in order to determine the fetal well-being. DV is usually visualized by the color Doppler mapping. We observed the instantaneous spectral flow type changes in pulsed Doppler examinations in spite of performing with the correct technique published by several authors. The variability of the pattern makes the sonographer/physician to be unsure for the correct placements of the sample gate despite fulfilling the all the criteria required for the vessel sampling. This prospective study was conducted between January 2016 and February 2017. We think that the fetal circulation is complicated more than estimated. There might be some endocrine agents released in the instantaneous physiologic reactions and changing the venous return abruptly or due to decreasing of the cardiac output directed to the placenta after 34 weeks influence the volume of the circulating blood in the fetus and so thereby the flow velocities instantaneously. The spectral waveform recognition approach is not reliable to identify if the DV spectral Doppler pattern is not the classic (standard) type and the DV should be visualized by wide-band color Doppler techniques particularly in the third trimester for the pulsed Doppler examinations. Studies are needed to evaluate the normal spectral variants of the flows correlated with the physiological compensatory mechanisms."
  • Maternal diabetes alters the development of ductus venosus shunting in the fetus[5] "Despite adequate glycemic control, the risks of fetal macrosomia and perinatal complications are increased in diabetic pregnancies. Adjustments of the umbilical venous (UV) distribution, including increased ductus venosus (DV) shunting, can be important fetal compensatory mechanisms, but the impact of pregestational diabetes on UV and DV flow is not known. In pregnancies with pregestational diabetes mellitus, prioritized UV distribution to the fetal liver, and lower DV shunt capacity, both reduce the compensatory capability of the fetus and may represent an augmented risk during hypoxic challenges during late pregnancy and birth." maternal diabetes
More recent papers  
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Search term: Ductus Venosus | Patent Ductus Venosus | hydrops fetalis

Older papers  
These papers originally appeared in the Some Recent Findings table, but as that list grew in length have now been shuffled down to this collapsible table.

See also the Discussion Page for other references listed by year and References on this current page.

  • Reference ranges for ductus venosus velocity ratios in pregnancies with normal outcomes[6] "Singleton pregnancies from 11 to 38 weeks with exactly established gestational ages (GAs) were recruited for the study. A total of 902 velocity wave ratios and ductus venosus PIVs were used for reference ranges. The S/v, S/D, and v/D ratios were not changed with GA (P > .05 for all). The PIV and S/a, v/a, and D/a ratios were reduced with GA (P < .0001 for all). Significant reductions in the means and standard deviations of the PIV and S/a, v/a, and D/a ratios were observed between 17 and 18 weeks' gestation. Therefore, nomograms were separately created between 11 and 17 weeks and 18 and 38 weeks."

Embryonic Development

Stage 13

Stage 13 image 075.jpg

Gray0475.jpg Human Embryo Liver and Associated Veins

Human embryo liver ventral surface view. Figure after {{His)).

  • ductus venosus - shunts approximately half the umbilical vein blood flow directly to the inferior vena cava.
  • portal vein - carries blood from the gastrointestinal tract and spleen to the liver.
  • left umbilical vein - carries oxygenated blood from the placenta to the embryo/fetus.
  • right umbilical vein - vessel degenerates leaving a single (left) umbilical vein.
  • vena revehentes - veins from the sinusoid vessels in the liver to the inferior vena cava, that later develop into the hepatic veins.

Stage 22

Stage 22 image 083.jpg


Fetal Development

Fetal ductus venosus ultrasound

Fetal ductus venosus ultrasound[7]


Links: ultrasound

Physiology

Fetal ductus venosus pressure wave 01.jpg

Fetal ductus venosus pressure wave

Abnormalities

Patent Ductus Venosus

Failure of the ductus venosus to close may result in a range of down-stream effects including: galactosemia, hypoxemia, encephalopathy with hyperammonia, and hepatic dysfunction.[3]

Patent or Persistent ductus venosus (postnatal 8 years) connecting the left portal vein to the inferior vena cava.[8]

Postnatal persistant ductus venosus ultrasound 02.jpg Postnatal persistant ductus venosus ultrasound 03.jpg
Tomography Two-dimensional echocardiography
Postnatal persistant ductus venosus ultrasound 03.jpg
 ‎‎Patent
Ductus Venosus
Page | Play


Links: Computed Tomography | OMIM 601466 Patent Ductus Venosus

References

  1. Kiserud T. (2001). The ductus venosus. Semin. Perinatol. , 25, 11-20. PMID: 11254155
  2. Fugelseth D, Lindemann R, Liestøl K, Kiserud T & Langslet A. (1997). Ultrasonographic study of ductus venosus in healthy neonates. Arch. Dis. Child. Fetal Neonatal Ed. , 77, F131-4. PMID: 9377136
  3. 3.0 3.1 Poeppelman RS & Tobias JD. (2018). Patent Ductus Venosus and Congenital Heart Disease: A Case Report and Review. Cardiol Res , 9, 330-333. PMID: 30344833 DOI.
  4. Gürses C, Karadağ B & İsenlik BST. (2018). Normal variants of ductus venosus spectral Doppler flow patterns in normal pregnancies. J. Matern. Fetal. Neonatal. Med. , , 1-7. PMID: 30153762 DOI.
  5. Lund A, Ebbing C, Rasmussen S, Kiserud TW & Kessler J. (2018). Maternal diabetes alters the development of ductus venosus shunting in the fetus. Acta Obstet Gynecol Scand , , . PMID: 29752712 DOI.
  6. Turan OM, Turan S, Sanapo L, Willruth A, Wilruth A, Berg C, Gembruch U, Harman CR & Baschat AA. (2014). Reference ranges for ductus venosus velocity ratios in pregnancies with normal outcomes. J Ultrasound Med , 33, 329-36. PMID: 24449737 DOI.
  7. da Silva FC, de Sá RA, de Carvalho PR & Lopes LM. (2007). Doppler and birth weight Z score: predictors for adverse neonatal outcome in severe fetal compromise. Cardiovasc Ultrasound , 5, 15. PMID: 17374167 DOI.
  8. Subramanian V, Kavassery MK, Sivasubramonian S & Sasidharan B. (2013). Percutaneous device closure of persistent ductus venosus presenting with hemoptysis. Ann Pediatr Cardiol , 6, 173-5. PMID: 24688239 DOI.

Reviews

Kiserud T. (2001). The ductus venosus. Semin. Perinatol. , 25, 11-20. PMID: 11254155

Articles

Fugelseth D, Lindemann R, Liestøl K, Kiserud T & Langslet A. (1997). Ultrasonographic study of ductus venosus in healthy neonates. Arch. Dis. Child. Fetal Neonatal Ed. , 77, F131-4. PMID: 9377136

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Cite this page: Hill, M.A. (2019, April 25) Embryology Cardiovascular System - Ductus Venosus. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Cardiovascular_System_-_Ductus_Venosus

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© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G