Talk:Cardiovascular System - Ductus Venosus
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Cite this page: Hill, M.A. (2020, May 25) Embryology Cardiovascular System - Ductus Venosus. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Talk:Cardiovascular_System_-_Ductus_Venosus
Kalayci H, Yilmaz Baran Ş, Doğan Durdağ G, Yetkinel S, Alemdaroğlu S, Özdoğan S, Yüksel Şimşek S & Bulgan Kiliçdağ E. (2020). Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13+6 weeks of gestation. J. Matern. Fetal. Neonatal. Med. , 33, 1134-1139. PMID: 30157671 DOI. Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13+6 weeks of gestation
Abstract Purpose: The ductus venosus pulsatility index velocity (DV PIV) has become a popular ultrasonographic measurement during the first trimester of pregnancy. The value of the DV PIV has been the topic of ongoing discussion in the literature, and its reference value in the normal population has not yet been established. Therefore, we aimed to determine a reference value for the DV PIV.Materials and Methods: We retrospectively evaluated our records of first-trimester ultrasonography performed between 2016 and 2017. Our inclusion criteria were as follows: singleton pregnancy; crown-rump length (CRL) between 45 and 84 mm; absence of structural abnormalities on the ultrasound examination; and absence of chromosomal abnormalities. Records of 820 patients were evaluated. According to the inclusion criteria, records of 458 patients were included in this study. All ultrasound examinations were performed by a single operator with the Voluson E8 (5- to 8-MHz 3 D transducer; General Electric Healthcare, Little Chalfont, UK) via the transabdominal route. Gestational weeks were designated according to CRL measurements at the beginning of the examination. Nuchal translucency (NT), nasal bone visualization (NB), tricuspid valve regurgitation (TR), "a"-wave pattern, DV PIV, S-wave (peak systolic velocity), D-wave (peak diastolic velocity), a-wave (atrial contraction in late diastole), and time-averaged maximum velocity (TAMXV) measurements were performed. To evaluate the DV Doppler images, a mid-sagittal view of the fetal profile was obtained. Color Doppler and pulse Doppler gate were used in the distal portion of the umbilical sinus, and at least three typical DV waveforms were detected. The SPSS 21.0 statistical program (IBM, Armonk, NY) was used to analyze variables.Results: The mean age, body mass index, CRL, gestational age, and NT values were 30.3 years (range, 18-45), 23.9 kg/m2 (range, 15.5-46.6), 59.5 mm (range, 45-79), 12.3 weeks (range, 11.2-13.6), and 1.58 mm (range, 0.73-2.62), respectively. The median gravidity and parity were 2 (1-8) and 0 (0-4), respectively. The "a"-wave pattern was identified in all cases, but TR was not detected in any of the cases. Measurements of DV PIV with a Gaussian distribution were suitable according to the Shapiro-Wilk test (p = .252). The mean DV PIV was 0.98, and the fifth and 95th percentiles were 0.73 and 1.22 (±2 SD), respectively. A statistical analysis of our cohort revealed that DV PIV values less than 0.73 and more than 1.22 were beyond the normal range. The mean S-wave, D-wave, a-wave, and TAMXV values were 31.18, 25.64, 8.68, and 22.72 cm/s, respectively.Conclusions: The value of DV PIV measurements is debated in the literature. Using our cohort, we defined the means and ranges of DV PIV. Determining the normal ranges of DV PIV could be helpful to anticipate congenital or chromosomal abnormalities. Further studies are needed to demonstrate the clinical importance of DV PIV, especially for patients with abnormal DV PIV measurements. KEYWORDS: Doppler; First trimester; ductus venosus; pulsatility index; reference range
Normal variants of ductus venosus spectral Doppler flow patterns in normal pregnancies
J Matern Fetal Neonatal Med. 2018 Oct 1:1-7. doi: 10.1080/14767058.2018.1517323. [Epub ahead of print]
Gürses C1, Karadağ B2, İsenlik BST2.
OBJECTIVES: 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. It is aimed in the study to define variations of the normal DV spectral flow types in the duration of the pulsed Doppler examinations instead of in a single cardiac cycle in normal pregnancies.
METHODS: This prospective study was conducted between January 2016 and February 2017. Wide-band Doppler technique was used for color mapping of the DV. Normal spectral Doppler waveforms in pregnancies are classified as types. When DV spectral flow pattern was not in the standard type, the spectral flow patterns were obtained from not only the umbilical artery and/or middle cerebral artery. Maximum and minimum blood flow velocities in the umbilical vein are measured. All Doppler examinations are performed by a single experienced specialist (CG), who had been certificated for DV flow and Doppler examinations by the Fetal Medicine Foundation.
RESULTS: A total of seven types of flow patterns were recorded during the study period and DV flow patterns were divided into two main categories as classic flow pattern and the other patterns. The classic pattern was observed in 160 (99.4%) cases in the first trimester, 495 (94.1%) cases in the second trimester and 206 (60.8%) cases in the third trimester.
CONCLUSIONS: 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.
KEYWORDS: Doppler; ductus venosus; prenatal diagnosis; pulsed; ultrasonography PMID: 30153762 DOI: 10.1080/14767058.2018.1517323
Patent Ductus Venosus and Congenital Heart Disease: A Case Report and Review
Cardiol Res. 2018 Oct;9(5):330-333. doi: 10.14740/cr777w. Epub 2018 Oct 7.
Poeppelman RS1, Tobias JD2,3.
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. KEYWORDS: Congenital heart disease; Patent ductus venosus; Portosystemic shunt PMID: 30344833 PMCID: PMC6188041 DOI: 10.14740/cr777w
Maternal diabetes alters the development of ductus venosus shunting in the fetus
Acta Obstet Gynecol Scand. 2018 May 11. doi: 10.1111/aogs.13363. [Epub ahead of print]
Lund A1,2, Ebbing C1,2, Rasmussen S1,2, Kiserud TW2, Kessler J1,2.
INTRODUCTION: 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. MATERIAL AND METHODS: In this prospective study, 49 women with pregestational diabetes mellitus underwent monthly ultrasound examinations from gestational week 20 to 36. The blood velocity and the mean diameters of the UV and DV were used for calculating blood flow volumes. The development of the UV flow, DV flow and DV shunt fraction (% of UV blood shunted through the DV) was compared with a reference population, and the effect of HbA1c on the DV flow was assessed. RESULTS: The UV flow was larger in pregnancies with pregestational diabetes mellitus than in low-risk pregnancies (p<0.001), but smaller when normalized for fetal weight (p=0.036). The distributional pattern of the DV flow developed differently in diabetic pregnancies, particularly during the third trimester, being smaller (p=0.007), also when normalized for fetal weight (p<0.001). Correspondingly the DV shunt fraction was reduced (p<0.0001), most prominently at 36 weeks. There were negative relations between the maternal HbA1c and the DV flow velocity, flow volume and shunt fraction. CONCLUSIONS: 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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved. KEYWORDS: Fetal Monitoring; Gestational diabetes mellitus; High-Risk Pregnancy; Morbidity; Prenatal care; Stillbirth; Ultrasound PMID: 29752712 DOI: 10.1111/aogs.13363
Reference ranges for ductus venosus velocity ratios in pregnancies with normal outcomes
J Ultrasound Med. 2014 Feb;33(2):329-36. doi: 10.7863/ultra.33.2.329.
Turan OM1, Turan S, Sanapo L, Wilruth A, Berg C, Gembruch U, Harman CR, Baschat AA.
OBJECTIVES: The purpose of this study was to establish reference ranges for ductus venosus velocity ratios. METHODS: Singleton pregnancies from 11 to 38 weeks with exactly established gestational ages (GAs) were recruited for the study. Pregnancies with fetal anomalies, growth abnormalities, maternal medical complications, stillbirth, birth weight below the 10th or above the 90th percentile, and neonatal anomalies were excluded. The ductus venosus pulsatility index for veins (PIV) and velocity ratios (S/v, S/D, v/D, S/a, v/a, and D/a, where S indicates ventricular systole [s-wave], v, ventricular end-systolic relaxation [v-descent], D, passive diastolic ventricular filling [D-wave], and a, active ventricular filling during atrial systole [a-wave]) were calculated. Separate regression models were fitted to estimate the mean and standard deviation at each GA for each ratio. RESULTS: 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. CONCLUSIONS: We created reference ranges for ductus venosus velocity ratios between 11 and 38 weeks' gestation in normal pregnancies. These reference ranges may prove beneficial for evaluation of fetal conditions that are associated with cardiovascular abnormalities. KEYWORDS: ductus venosus; obstetric ultrasound; reference ranges; sonography; velocities
Ductus Venosus Doppler Flow Velocity after Transplacental and Non-transplacental Amniocentesis during Midtrimester
Pak J Med Sci. 2014 Sep;30(5):992-5. doi: 10.12669/pjms.305.5065.
Artunc Ulkumen B1, Pala HG2, Baytur YB3, Koyuncu FM4.
OBJECTIVE: We aimed to evaluate ductus venosus Doppler waveforms before and after amniocentesis in order to investigate any effect of amniocentesis on fetal myocardial hemodynamics. We also evaluated the umbilical artery, uterine artery and fetal mid-cerebral artery Doppler waveforms in order to investigate any relationship with ductus venosus Doppler changes. METHODS: The study population consisted of 56 singleton pregnancies having genetic amniocentesis. Twenty seven of them had transplacental needle insertion; whereas 29 of them had non-transplacental amniocentesis. Uterine artery, umbilical artery, mid-cerebral artery and ductus venosus pulsatiliy index and resistance index were measured just before and after amniocentesis. RESULTS: Amniocentesis does not cause any significant changes in fetal ductus venosus Doppler waveforms. There is also no significant changes in uterine artery, umbilical artery, mid-cerebral artery pulsatility and resistance index. CONCLUSION: Amniocentesis-whether transplacental or not- does not cause any significant effect on fetal myocardial hemodynamics. KEYWORDS: Amniocentesis; Ductus venosus Doppler; Mid-cerebral artery Doppler; Umbilical artery Doppler; Uterine artery Doppler
The role of ductus venosus Doppler flow in the diagnosis of chromosomal abnormalities during the first trimester of pregnancy
Adv Clin Exp Med. 2013 May-Jun;22(3):395-401.
Florjański J1, Fuchs T, Zimmer M, Homola W, Pomorski M, Blok D.
BACKGROUND: The ductus venosus (DV) is an intrahepatic end-part of the umbilical vein. Inappropriate first trimester DV Doppler blood flow patterns correspond to a higher risk of chromosomal abnormalities. OBJECTIVES: The aim of the study was to assess the usefulness of ductus venosus Doppler flow in a first trimester screening for aneuploidies. MATERIAL AND METHODS: A prospective study included 1526 singleton pregnancies with increased risk of chromosomal abnormalities who underwent prenatal first trimester screening between the years 2006-2009. All ultrasound scans were performed by experienced sonographers and included an assessment of fetal growth, nuchal translucency (NT), nasal bone assessment (NB) and ductus venosus (DV) blood flow. Reversed a-wave (atrial diastole) in the ductus venosus flow pattern was recognized as abnormal. In addition to DV blood flow, the levels of pregnancy-associated plasma protein-A (PAPP-A) and free β - human chorionic gonadotropin (β-hCG) in maternal serum were measured. The risk of chromosomal abnormalities was calculated using the Fetal Medicine Foundation software. The following risk levels were assumed: high risk results - 1:100 or lower, intermediate risk 1:100 - 1:1000, and low risk above 1:1000. In 523 pregnancies, patients underwent amniocentesis and karyotyping. RESULTS: The authors diagnosed 46 cases with chromosomal abnormalities (using amniocentesis and karyotyping). 29 patients had spontaneous miscarriage, in 21 cases they reported fetuses with congenital malformations (mostly heart defects). Abnormal DV blood flow was recognized in 113 pregnant women (7.4%). The majority of cases affected by abnormal DV blood flow were classified as intermediate and high disorder risk groups - 100 (6.5%). The comparison between a combined test with and without DV assessment revealed that the addition of DV flow pattern results increased sensitivity from 84% to 92% in screening for aneuploidies. The false-positive ratio was between 0.4% and 2.4%. CONCLUSIONS: Ductus venosus Doppler blood flow examination is useful in the first trimester prenatal diagnostic since it increases the sensitivity of the combined test in the assessment of risk for chromosomal abnormalities. The authors recommend assessing DV blood flow during the first trimester screening in all pregnancies, irrespectively of the chromosomal abnormalities background risk. This procedure in clinical practice seems to be favorable and less complicated.
Percutaneous device closure of persistent ductus venosus presenting with hemoptysis
Ann Pediatr Cardiol. 2013 Jul;6(2):173-5. doi: 10.4103/0974-2069.115274.
Subramanian V1, Kavassery MK1, Sivasubramonian S1, Sasidharan B1.
An eight-year-old boy was evaluated for unexplained hemoptysis and cyanosis. A contrast echocardiogram was suggestive of pulmonary arteriovenous fistula. Further evaluation revealed persistent ductus venosus (PDV) and aortopulmonary collaterals. Both the PDV and aortopulmonary collaterals were closed percutaneously. PDV is amenable for device closure after detailed anatomical evaluation. Prior to closure, it is important to ensure adequate portal vein arborization into the liver and normal portal pressure after test balloon occlusion. KEYWORDS: Pulmonary arteriovenous fistula; persistent ductus venosus; portal vein and device
Ultrasonographic study of ductus venosus in healthy neonates
Arch Dis Child Fetal Neonatal Ed. 1997 Sep;77(2):F131-4.
Fugelseth D1, Lindemann R, Liestøl K, Kiserud T, Langslet A.
AIM: To assess ultrasonographically the flow pattern and the time of postnatal closure of ductus venosus related to the other fetal shunts. METHODS: Fifty healthy, term neonates were studied from day 1 up to day 18 using a VingMed CFM 800A ultrasound scanner. RESULTS: Ductus arteriosus was closed in 94% of the infants before day 3. Ductus venosus, however, was closed in only 12% at the same time, in 76% before day 7, and in all infants before day 18. A closed ductus venosus or ductus arteriosus did not show signs of reopening. Pulsed and colour Doppler flow could be detected across the foramen ovale in all infants during the sequential investigation. At day 1, when the pulmonary vascular resistance was still high, a reversed Doppler flow velocity signal was seen in ductus venosus in 10 infants (20%) and a bidirectional flow in ductus arteriosus in 26 (52%). Closure of the ductus venosus was not significantly correlated with closure of the ductus arteriosus nor related to sex nor weight loss. CONCLUSIONS: The time of closure of the ductus venosus evaluated by ultrasonography is much later than that of the ductus arteriosus. The flow pattern in ductus venosus reflects the portocaval pressure gradient and the pressure on the right side of the heart and in the pulmonary arteries. Both the flow pattern in the ductus venosus as well as that in the ductus arteriosus may be an indication of compromised neonatal haemodynamics.
1859 The Ductus Venosus
Jackson JBS. The ductus venosus. (1859) Extra. Rec. Bost. Soc. Med. Impr. 3: 296.
JACKSON, J. B. S. 1859 The ductus venosus. Extra. Rec. Bost. Soc. Med. Impr., vol. 3, p. 296.
Dec 27th. — The Ductus Venosus. - Dr. Jackson said that in all of the modern text-books on anatomy, as far as he had consulted them, with one exception, this vessel is described as terminating in the vena cava, and in some of them it is so figured ; the figures, which have the appearance of coarse diagrams, representing the opening at some distance below the opening of the vena cava into the auricle. Many years ago he had been struck with the error of this statement, as applied to his own dissections ; and he had never yet seen it confirmed, although he had often examined this point. The ductus venosus terminates, so far as Dr. J. has observed, in one of the hepatic veins, near, and sometimes close to the opening of this last into the vena cava.
Mr. John Bell's work on anatomy, published in 1802, would, perhaps, hardly be considered as a modern text-book, but this is the one above referred to. He figures the ductus venosus as opening into one of the hepatic veins, and further from the vena cava than Dr. J. has found it to open. In the text, there is some looseness of description ; he says that the vessel in question "joins the largest of the hepatic veins, and along with it, goes directly into the right auricle of the heart and on the following page, he says that the ductus venosus goes to the back part of the liver and " enters the heart." Dr. Hodges, with whom Dr. J. had had some conversation upon the subject, recently, had since then examined several authorities, and called his attention to Cazeaux's work on midwifery, in which it is stated that the ductus venosus " goes sometimes to the vena cava inferior above the diaphragm, though at others it joins one of the hepatic veins 77 (Philadelphia edition). Dr. H. further remarked that in the very recent and excellent work on anatomy by Mr. Gray, the ductus venosus is said to open into the vena cava.
[Since the above report to the Society, Dr. J. has had shown to him by Dr. H., a small volume by Mr. John Struthers, of Edinburgh (Anatomical and Physiological Observations, 1854), which had been received within a day or two from Europe, and in which it is stated that the ductus venosus "enters not the vena cava but the left hepatic vein, about a quarter of an inch before the latter ends in the vena cava." Dr. Dalton, in his work on physiology, just published, also speaks of the ductus venosus as terminating in the hepatic vein.]
It is a question of very little if any physiological importance whether the ductus venosus opens into one of the hepatic veins near to the vena cava, or directly into the vena cava itself; though the flow into the heart of the purified blood that passes through the ductus venosus might be somewhat impeded if this vessel really opened into the vena cava at some distance from the auricle, as figured in one of the most common of all text-books ( Wilson's). Dr. J. said that he intended merely to remark upon the anatomical fact, and upon the present case as one of too many in which errors are perpetuated in the text-books of medical science. He was led at this present time to make the above remarks from having had Wilson's work shown to him by a student, after he had been giving what he believed to be a correct description of the ductus venosus ; and from finding that some of his friends, who have paid particular attention to anatomy, entertained the idea, in regard to this vessel, that is so generally taught in the text-books.
Dr. J. illustrated his remarks by an injected specimen from the Society's Cabinet, and said that four or five others, equally satisfactory, might have been shown.
The Boston Medical And Surgical Journal. Edited By W. W. Morland, M.D., And Francis Minot, M.D. https://archive.org/details/bostonmedicalsur6018mass
Extracts From The Records Of The Boston Society For Medical Improvement. By F. E. Oliver, M.D., Secretary.