Spontaneous Echocardiographic Contrast Associated with Portosystemic Shunt Due to Persistent Patent Ductus Venosus

Abstract

We describe a case of an infant with a single ventricle physiology, who presented with spontaneous microbubbles originating from her inferior vena cava. Imaging revealed a persistent patent ductus venosus, leading to a portosystemic shunt, streaming the microbubbles into the heart. We discuss the possible mechanisms for this rare phenomenon in a child.

Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart

“…This may reveal or at least raise the suspicion of a portosystemic shunt [91,94,95,97,99,102,103,105,106]. Magnetic resonance angiography has also been suggested as an important diagnostic tool, specifically for infants [108].…”

“…Manifestations reported include cholestatic jaundice [ 93 - 100 ], hepatic encephalopathy [ 91 , 94 , 95 , 99 ], massive gastrointestinal bleeding [ 98 ]; acute liver failure [ 99 , 101 ]; respiratory distress [ 102 ] and pulmonary arteriovenous fistulae [ 103 , 104 ], and tumor-like hepatic lesions [ 92 , 105 ]. A child with a single ventricle, who presented with spontaneous microbubbles on echocardiography, was found to have a PDV [ 106 ]. Other peculiar associations have been reported.…”

“…Usually, biochemical alterations suggest a hepatic disorder, and a liver ultrasound or abdominal computed tomography (with or without angiographic study) is performed. This may reveal or at least raise the suspicion of a portosystemic shunt [ 91 , 94 , 95 , 97 , 99 , 102 , 103 , 105 , 106 ]. Magnetic resonance angiography has also been suggested as an important diagnostic tool, specifically for infants [ 108 ].…”