In vivo measurement of dimensions of veins with implications regarding control of venous return

Blood reservoir function in patients with Fontan circulation and asplenia syndrome

Splanchnic circulation constitutes a major portion of the vasculature capacitance and plays an important role in maintaining blood perfusion. Because patients with asplenia syndrome lack this vascular bed as a blood reservoir, they may have a unique blood volume and distribution, which may be related to their vulnerability to the haemodynamic changes often observed in clinical practice. During cardiac catheterisation, the mean circulatory filling pressure was calculated with the Valsalva manoeuvre in 19 patients with Fontan circulation, including 5 patients with asplenia syndrome. We also measured the cardiac output index and circulatory blood volume by using a dye dilution technique. The blood volume and the mean circulatory filling pressure and the venous capacitance in patients with asplenia syndrome were similar to those in the remaining patients with Fontan circulation (85 ± 14 versus 77 ± 18 ml/kg, p = 0.43, 31 ± 8 versus 27 ± 5 mmHg, p = 0.19, 2.8 ± 0.6 versus 2.9 ± 0.9 ml/kg/mmHg, p = 0.86). Unexpectedly, our data indicated that patients with asplenia syndrome, who lack splanchnic capacitance circulation, have blood volume and venous capacitance comparable to those in patients with splanchnic circulation. These data suggest that (1) there is a blood reservoir other than the spleen even in patients with asplenia; (2) considering the large blood pool of the spleen, the presence of a symmetrical liver may represent the possible organ functioning as a blood reservoir in asplenia syndrome; and (3) if this is indeed the case, there may be a higher risk of hepatic congestion in patients with Fontan circulation with asplenia syndrome than in those without.

Diameter and blood velocity changes in the saphenous vein during thermal stress

Although volume, pressure or flow in superficial veins have been studied extensively, little is known about venous blood velocity during thermal stress. Most authors have suggested that the velocity is decreased in the dilated superficial veins during heat stress to facilitate heat loss, and is increased during cooling as the vein is constricted. Duplex ultrasound has been used to study saphenous cross sectional area (CSA) and mean maximal venous blood velocity (BV) in ten healthy volunteers (age 22-31 years). Compared with unstressed mean values, 4.8 (SD 2.6) mm2, CSA increased to 9.3 (SD 2.1) mm2 (P < 0.005) during heat stress and decreased to 2.1 (SD 1.9) mm2 (P < 0.005) during cold stress. These results are consistent with previous studies, but the absolute CSA of the saphenous vein has never been estimated during thermal stress. The BV increased from 0.07 (SD 0.02) m.s-1 to 0.29 (SD 0.11) m.s-1 (P < 0.005) during warming. During cooling, BV tended to decrease: 0.05 (SD 0.03) m.s-1 (N.S). We would suggest that heat loss during thermal stress can be facilitated by the rapid turnover of warm blood, and not (as usually suggested) by the prolonged cooling of each blood sample in the dilated superficial veins.

Diameter and velocity changes in the femoral vein during thermal stress in humans

Unlike most studies on deep veins performed with simultaneous suppression of cutaneous blood flow, a sonographic study of femoral diameter and blood flow velocity changes in response to thermal stress was performed while cutaneous flow was preserved. In 11 normal subjects, mean peak blood flow velocity and diameter of the femoral vein were measured at rest and during indirect whole body heating and cooling. Mean peak venous blood flow velocity was 0.12 +/- 0.06 m s-1 at rest, 0.35 +/- 0.23 m s-1 (P < 0.001) during heat stress, and 0.13 +/- 0.07 m s-1 during cold stress (NS). Femoral venous diameter was 5.3 +/- 0.9 mm at rest, 5.1 +/- 1.0 mm (P < 0.05) during warming, and 5.4 +/- 81.0 mm (NS) during cooling. This study showed a decrease in diameter during thermal stress. However, as mean femoral venous blood-flow velocity was doubled during heat stress, femoral venous blood flow was increased. Thus, it is suggested that during heat stress part of the increase in cutaneous flow is returned through deep veins.