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Braga M, Moleiro ML, Guedes-Martins L. Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart. Curr Cardiol Rev 2019; 15:167-176. [PMID: 30644348 PMCID: PMC6719393 DOI: 10.2174/1573403x15666190115142303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 12/17/2022] Open
Abstract
The ductus venosus is a vascular shunt situated within the fetal liver parenchyma, connecting the umbilical vein to the inferior vena cava. This vessel acts as a bypass of the liver microcirculation and plays a critical role in the fetal circulation. The ductus venosus allows oxygenated and nutrient-rich venous blood to flow from the placenta to the myocardium and brain. Increased impedance to flow in the fetal ductus venosus is associated with fetal aneuploidies, cardiac defects and other adverse pregnancy outcomes. This review serves to improve our understanding of the mechanisms that regulate the blood flow redistribution between the fetal liver circulation and fetal heart and the clinical significance of the ductus venosus waveform as generated by pressure-volume changes in the fetal heart.
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Affiliation(s)
- Madalena Braga
- Instituto de Ciencias Biomedicas Abel Salazar, University of Porto, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciencias Biomedicas Abel Salazar, University of Porto, Porto, Portugal.,Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Porto, Portugal.,Unidade de Investigacao e Formacao, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal
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2
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Maruotti GM, Saccone G, Ciardulli A, Mazzarelli LL, Berghella V, Martinelli P. Absent ductus venosus: case series from two tertiary centres. J Matern Fetal Neonatal Med 2017. [DOI: 10.1080/14767058.2017.1344637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrea Ciardulli
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Laura Letizia Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
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DeVore GR, Tabsh K, Polanco B, Satou G, Sklansky M. Fetal Heart Size: A Comparison Between the Point-to-Point Trace and Automated Ellipse Methods Between 20 and 40 Weeks' Gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2543-2562. [PMID: 27738291 DOI: 10.7863/ultra.16.02019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/13/2016] [Accepted: 03/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate whether the global area and circumference of the heart varies between two measurement techniques: the point-to-point trace and the electronic ellipse methods. METHODS The epicardial border of the 4-chamber view was measured in 200 fetuses between 20 and 40 weeks' gestation, from which the area and circumference using the point-to-point trace and electronic ellipse were measured. Analysis of variance, correlation, and regression analysis using fractional polynomials and 7 independent variables (head circumference, biparietal diameter, abdominal circumference, femur length, estimated fetal weight, mean ultrasound gestational age, and last menstrual period gestational age) were performed. RESULTS The correlation between the mean ultrasound gestational age and last menstrual period gestational age was 0.9880 (5% confidence limit, 0.9716; 95% confidence limit, 0.9880), with an R2 of 0.9762. The R2 value for the 7 independent variables regressed against the area and circumference using the point-to-point trace and electronic ellipse methods ranged between 0.885 and 0.965. Comparison of Z scores between this study and previous publications demonstrated that there were differences and similarities, depending on whether the area or circumference was measured. CONCLUSIONS This study shows high R2 values when comparing measurements of the area and circumference against 7 independent variables, irrespective of whether the point-to-point trace or the electronic ellipse method was used to obtain the measurements. A calculator to evaluate the area and circumference is provided, using 7 independent variables from which Z scores and percentiles for individual measurements can be computed.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Kareem Tabsh
- Department of Obstetrics and Gynecology, Kern Medical Center, Bakersfield, California USA
| | - Bardo Polanco
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
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Moaddab A, Tonni G, Grisolia G, Bonasoni MP, Araujo Júnior E, Rolo LC, Prefumo F, de la Fuente S, Sepulveda W, Ayres N, Ruano R. Predicting outcome in 259 fetuses with agenesis of ductus venosus - a multicenter experience and systematic review of the literature (.). J Matern Fetal Neonatal Med 2016; 29:3606-14. [PMID: 26809266 DOI: 10.3109/14767058.2016.1144743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate prenatal predictors of postnatal survival in fetuses with agenesis of ductus venosus (ADV). METHODS This retrospective study reviewed our experience and the literature between 1991 and 2015. Prenatal findings were evaluated and perinatal morbidity and mortality was documented. RESULTS A total of 259 cases were included in the present analysis from our centers and 49 published studies (15 patients from our retrospective cohort review and 244 from literature review). The intrahepatic and extrahepatic shunts were present in 32.0% (73/226) and 67.7% (153/226), respectively. Cardiomegaly (n = 64/259, 24.7%), hydrops (n = 31/259, 12.0%) and amniotic fluid abnormalities (n = 22/259, 8.5%) were among the most frequent initial ultrasound findings. One hundred and forty-seven fetuses (56.8%) had ADV without structural anomalies while 112 (43.2%) had associated anomalies (cardiac anomalies (n = 66), extra-cardiac anomalies (n = 19) and both cardiac and extra-cardiac anomalies (n = 27)). The mean gestational age (GA) at ultrasound diagnosis was 22.9 ± 6.9 weeks while the mean GA at delivery was 34 ± 7.5 weeks. The overall neonatal survival was 57.1% (n = 148/259). The following factors were associated with survival: advanced maternal age, earlier GA at diagnosis, prematurity, increased nuchal translucency, pericardial effusion, associated cardiac defects (especially AVSD), chromosomal abnormalities, hydrops, hygroma and limb anomalies. CONCLUSION Fetal hydrops, the presence of associated congenital anomalies and premature delivery are associated with poor prognosis in fetuses with ADV.
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Affiliation(s)
- Amirhossein Moaddab
- a Department of Obstetrics and Gynecology , Texas Children's Hospital Fetal Center and Baylor College of Medicine , Houston , TX , USA
| | - Gabriele Tonni
- b Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL , Reggio Emilia , Italy
| | - Gianpaolo Grisolia
- c Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, "Carlo Poma" Hospital , Mantua , Italy
| | - Maria Paola Bonasoni
- d Pathology Service, IRCCS Arcispedale "Santa Maria Nuova" , Reggio Emilia , Italy
| | - Edward Araujo Júnior
- e Department of Obstetrics , Paulista School of Medicine - São Paulo Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Lilliam Cristine Rolo
- e Department of Obstetrics , Paulista School of Medicine - São Paulo Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Federico Prefumo
- f Department of Obstetrics and Gynecology , University of Brescia , Brescia , Italy
| | | | - Waldo Sepulveda
- g Fetalmed - Maternal Fetal Diagnostic Center , Santiago , Chile , and
| | - Nancy Ayres
- h Department of Pediatric Cardiology , Texas Children's Hospital Fetal Center and Baylor College of Medicine , Houston , TX , USA
| | - Rodrigo Ruano
- a Department of Obstetrics and Gynecology , Texas Children's Hospital Fetal Center and Baylor College of Medicine , Houston , TX , USA
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Weissmann-Brenner A, Zalel Y. Umbilical vein insertion into the inferior vena cava: an ominous sign of chromosomal abnormalities? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2207-2210. [PMID: 25425381 DOI: 10.7863/ultra.33.12.2207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This series describes the sonographic characteristics and pregnancy outcomes of fetuses with abnormal insertion of the umbilical vein (UV) into the inferior vena cava (IVC). We conducted a retrospective study that described the sonographic features of 6 patients who underwent a routine anatomic scan during early pregnancy. Six patients had a diagnosis of abnormal insertion of the UV to the IVC; in 3, the diagnosis was made at 12 weeks' gestation. Cardiac anomalies were detected in 3 patients, including ventricular septal defects, pericardial effusion, tricuspid and mitral regurgitation, and an aberrant right subclavian artery. Four had noncardiac anomalies, including cystic hygroma and skeletal, brain, and abdominal anomalies. Only 1 fetus who presented with UV insertion into the IVC as an isolated finding had a normal karyotype, resulting in term vaginal delivery. Four other patients had chromosomal abnormalities, including trisomies 13 and 21, Turner mosaicism of 45,XO/46,XY, and Robertsonian translocation, and 1 patient terminated the pregnancy without a karyotype evaluation. Abnormal insertion of the UV into the IVC with agenesis of the ductus venosus can be seen as early as the first trimester. When detected, a detailed anatomic examination should be performed, as well as a fetal karyotype evaluation. Isolated cases of insertion of the UV into the IVC at a position lower than usual may have a good prognosis.
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Affiliation(s)
- Alina Weissmann-Brenner
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated With the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.
| | - Yaron Zalel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated With the Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
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Gore S, Smith M, Nessling C. Agenesis of the Ductus Venosus With Extrahepatic Umbilical Vein Connection Into the Right Atrium. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313480848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Agenesis of the ductus venosus is a rare anomaly that was first reported in literature within the past decade. Color/Doppler sonography is an important tool for mapping blood flow in determining this aberrant anastomosis. Careful observation of the fetus for signs of congestive heart failure can lead to a positive outcome. In the following case, cardiomegaly was detected and digoxin was introduced, which arrested progression into congestive heart failure.
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Affiliation(s)
- Sharon Gore
- Maternal Fetal Medicine of SW Florida, Fort Myers, FL, USA
| | - Melissa Smith
- Maternal Fetal Medicine of SW Florida, Fort Myers, FL, USA
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