Hemodynamic studies of isolated absent ductus venosus

Abstract

Objective The objective of this article is to evaluate hemodynamic changes among fetuses with isolated absent ductus venosus (IADV) diagnosed by prenatal ultrasonography. Patients and MethodsFetuses with prenatal diagnosis of IADV were recruited and followed. Hemodynamic assessment was performed in all cases, including measurement of cardiac dimensions, shortening fraction, myocardial performance index, preload index in the inferior vena cava and the presence of venous pulsations in the umbilical vein (UV).Results Nine fetuses of IADV were assessed, including six cases with extra-hepatic UV drainage and three with intrahepatic drainage. All fetuses with extra-hepatic UV drainage showed an elevated preload index in the inferior vena cava, venous pulsations in the UV and cardiomegaly. Of them, four had hydrops, two showed poor cardiac function and three resulted in perinatal mortality. Three cases with intra-hepatic drainage had continuous flow in the UV, normal in all hemodynamic parameters and all survived.Conclusion Hemodynamic assessment of fetuses with IADV was helpful in predicting the development of hydrops and perinatal mortality. The poor prognostic factors included cardiac overload, cardiomegaly, poor myocardial performance, increased preload, the presence of venous pulsations and extra-hepatic UV drainage.

A Newborn with an Alternative Porto-Caval Shunt

“…Some cardiac and extracardiac co-morbidities have also been described in the literature (cardiomegaly, duodenal atresia, intestinal malrotation, etc. ), but our patient had none of them [3,4,7]. …”

“…DV also regulates the blood flow rate in order to prevent the fetus from volume overload. Absence of DV with variations in direct blood flow from UV to IVC (or heart) can lead to high output cardiac failure and hydrops fetalis [3,4]. Functional closure of the DV occurs shortly after birth, however, anatomical closure takes several weeks.…”

EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease

“…A fetus with an absent ductus venosus, where the umbilical vein drains directly into the iliac veins or directly into the heart, is a rare but important anomaly of the fetal circulation. Normally the ductus venosus controls the amount of blood flow to the heart from the umbilical veins and absence of this structure can result in right heart volume over-load and lead to heart failure ( 22 , 23 ) ( Fig. 4 ).…”

Agenesis of the venous duct with abnormal return of the umbilical vein into the superior vena cava: A case report

“…In this condition, the umbilical vein (UV) returns directly to the atrium, portal sinus, and systemic veins. Blood flow from the placenta returning into the systemic venous system, without restriction by the venous duct, can result in an increased preload, leading to heart failure, fetal hydrops, and death 4 . To the best of our knowledge, there has been only one report of agenesis of the venous duct in which the UV drains into the superior vena cava (SVC).…”

“…Blood flow from the placenta returning into the systemic venous system, without restriction by the venous duct, can result in an increased preload, leading to heart failure, fetal hydrops, and death. 4 To the best of our knowledge, there has been only one report of agenesis of the venous duct in which the UV drains into the superior vena cava (SVC). We report a case of agenesis of the venous duct with abnormal drainage of the UV into the SVC with tetralogy of Fallot with pulmonary atresia.…”