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Czeiger S, Weissbach T, Zloto K, Wiener A, Nir O, Massarwa A, Weisz B, Bartal MF, Ulman RY, Bart Y, Achiron R, Kivilevitch Z, Mazaki-Tovi S, Kassif E. Umbilical-portal-systemic venous shunt and intrauterine growth restriction: an inquiry from a prospective study. Am J Obstet Gynecol 2024; 231:340.e1-340.e16. [PMID: 38218510 DOI: 10.1016/j.ajog.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The investigation of the fetal umbilical-portal venous system is based on the premise that congenital anomalies of this system may be related to adverse perinatal outcomes. Several small retrospective studies have reported an association between umbilical-portal-systemic venous shunts and intrauterine growth restriction. However, the prevalence of portosystemic shunts in the fetal growth restricted population is yet to be determined. OBJECTIVE The aims of this study were (1) to determine the prevalence of fetal umbilical-portal-systemic venous shunts in pregnancies complicated by intrauterine growth restriction and (2) to compare the perinatal and neonatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts. STUDY DESIGN This was a prospective, cross-sectional study of pregnancies diagnosed with intrauterine growth restriction, as defined by the Society for Maternal-Fetal Medicine intrauterine growth restriction guidelines. All participants underwent a detailed anomaly scan, supplemented with a targeted scan of the fetal portal system. Venous shunts were diagnosed using color Doppler mode. The perinatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts were compared. RESULTS A total of 150 cases with intrauterine growth restriction were recruited. The prevalence of umbilical-portal-systemic venous shunts in our cohort was 9.3% (n=14). When compared with the control group (intrauterine growth restriction without umbilical-portal-systemic venous shunts, n=136), the study group had a significantly lower mean gestational age at the time of intrauterine growth restriction diagnosis (29.7±5.6 vs 32.47±4.6 weeks of gestation; P=.036) and an earlier gestational age at delivery (33.50±6.0 vs 36.13±2.8; P=.005). The study group had a higher rate of fetal death (21.4% vs 0.7%; P<.001) and, accordingly, a lower rate of live births (71.4% vs 95.6%; P=.001). Additional associated fetal vascular anomalies were significantly more prevalent in the study group than in the control group (35.7% vs 4.4%; P≤.001). The rate of other associated anomalies was similar. The study group had a significantly lower rate of abnormal uterine artery Doppler indices (0% vs 40.4%; P=.011) and a higher rate of abnormal ductus venosus Doppler indices (64.3% vs 23%; P=.001). There were no cases of hypertensive disorders of pregnancy in the study group, whereas the control group had an incidence of 12.5% (P=.16). Other perinatal and neonatal outcomes were comparable. CONCLUSION Umbilical-portal-systemic venous shunt is a relatively common finding among fetuses with growth restriction. When compared with pregnancies with intrauterine growth restriction with a normal portal system, these pregnancies complicated by intrauterine growth restriction and an umbilical-portal-systemic venous shunt are associated with a different Doppler flow pattern, an increased risk for fetal death, earlier presentation of intrauterine growth restriction, a lower gestational age at delivery, additional congenital vascular anomalies, and a lower rate of pregnancy-induced hypertensive disorders. Meticulous sonographic evaluation of the portal system should be considered in the prenatal workup of intrauterine growth restriction, as umbilical-portal-systemic venous shunts may affect perinatal outcomes.
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Affiliation(s)
- Shelly Czeiger
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Department of Obstetrics and Gynecology, Mayanei HaYeshuha Medical Center, Bnei-Brak, Israel.
| | - Tal Weissbach
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Zloto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariella Wiener
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Nir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Fishel Bartal
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli Ulman
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zvi Kivilevitch
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Elbistanli C, Yozgat Y, Dogan MS, Yozgat CY, Kütük MS. Prenatal Detection and Postnatal Outcome of Persistent Left Superior Vena Cava and Agenesis of Ductus Venosus Associated with Postnatal Bovine Aortic Arch. Z Geburtshilfe Neonatol 2024; 228:294-297. [PMID: 38122805 DOI: 10.1055/a-2219-9889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Isolated agenesis of ductus venosus (ADV) is usually a benign condition, but it may be associated with cardiovascular defects, hydrops, growth restriction, and chromosomal abnormalities. Additionally, persistent left superior vena cava (PLSVC) and bovine aortic arch are relatively common fetal anomalies. To the author's knowledge, this is the first report of prenatal detection of DV agenesis and PLSVC associated with the postnatal bovine aortic arch with a hypoplastic transverse aortic arch. CASE A 25-year-old, G2P1 woman was referred to our department at 31 weeks due to fetal growth restriction and short femur. On fetal echocardiography, DV could not be viewed via two-dimensional (2D) and Doppler ultrasound (US) imaging; there was also evidence of the co-occurrence of PLSVC and an aortic arch anomaly. We revealed the intrahepatic continuation of the umbilical vein. A weekly follow-up program was scheduled for the patient and the rest of the pregnancy was uneventful. Postnatal, thorax computer tomography and transthoracic echocardiography (TTE) demonstrated PLSVC and bovine aortic arch associated with hypoplastic transverse aortic arch. Routine echocardiographic examinations revealed that the blood flow of the aortic arch had increased gradually, and the male infant's aortic arch had significantly widened and reached the normal range until the baby was discharged from the hospital. CONCLUSION DV agenesis and PLSVC are usually benign conditions but underlying serious heart diseases may accompany them. Therefore, in situations like ours, a prenatal aortic arch evaluation is of capital importance. Postnatal hemodynamic changes should be taken into consideration in the management of these cases. This is the first example in the literature that these abnormalities co-existed in one case.
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Affiliation(s)
| | - Yılmaz Yozgat
- Pediatric Cardiology, Istanbul Medipol Universitesi, Istanbul, Turkey
| | - Mehmet Said Dogan
- Pediatric Radiology, Istanbul Medipol Universitesi, Istanbul, Turkey
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McLin VA, Franchi-Abella S, Brütsch T, Bahadori A, Casotti V, de Ville de Goyet J, Dumery G, Gonzales E, Guérin F, Hascoet S, Heaton N, Kuhlmann B, Lador F, Lambert V, Marra P, Plessier A, Quaglia A, Rougemont AL, Savale L, Sarma MS, Sitbon O, Superina RA, Uchida H, van Albada M, van der Doef HPJ, Vilgrain V, Wacker J, Zwaveling N, Debray D, Wildhaber BE. Expert management of congenital portosystemic shunts and their complications. JHEP Rep 2024; 6:100933. [PMID: 38234409 PMCID: PMC10792643 DOI: 10.1016/j.jhepr.2023.100933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 01/19/2024] Open
Abstract
Congenital portosystemic shunts are often associated with systemic complications, the most challenging of which are liver nodules, pulmonary hypertension, endocrine abnormalities, and neurocognitive dysfunction. In the present paper, we offer expert clinical guidance on the management of liver nodules, pulmonary hypertension, and endocrine abnormalities, and we make recommendations regarding shunt closure and follow-up.
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Affiliation(s)
- Valérie Anne McLin
- Swiss Pediatric Liver Center, Gastroenterology, Hepatology and Pediatric
Nutrition Unit, Department of Pediatrics, Gynecology and Obstetrics, University
of Geneva, Geneva, Switzerland
- ERN RARE LIVER
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Centre de référence des maladies rares du foie de l’enfant,
Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital
Bicêtre, Le Kremlin-Bicêtre, France
- BIOMAPS UMR 9011 CNRS, INSERM, CEA, Orsay, France
- ERN RARE LIVER
- ERN Transplant Child
| | | | - Atessa Bahadori
- Department of Pediatrics, Gynecology and Obstetrics, University of
Geneva, Geneva, Switzerland
| | - Valeria Casotti
- ERN Transplant Child
- Pediatric Hepatology, Gastroenterology and Transplant Centre, ASST Papa
Giovanni XXIII Hospital, Bergamo, Italy
| | - Jean de Ville de Goyet
- Pediatric Department for the Treatment and Study of Abdominal Diseases
and Abdominal Transplantation, ISMETT UPMC, Palermo, Italy
| | - Grégoire Dumery
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Service de gynécologie et d’obstétrique, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Centre de référence des maladies rares du foie de l’enfant, FHU
Hepatinov, Service d’hépatologie et transplantation hépatique pédiatriques,
Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMRS_1193, Orsay, France
| | - Florent Guérin
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Service de chirurgie pédiatrique, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
| | - Sebastien Hascoet
- Department of Congenital Heart Diseases, Hôpital Marie Lannelongue,
France
- INSERM UMR_S 999, Université Paris, France
| | - Nigel Heaton
- Institute of Liver Studies, Kings College Hospital, London,
England
| | - Béatrice Kuhlmann
- Pediatric Endocrinology, Cantonal Hospital Aarau KSA, Aarau,
Switzerland
| | - Frédéric Lador
- Service de Pneumologie, University of Geneva, Geneva,
Switzerland
| | - Virginie Lambert
- AP-HP, Centre de référence des maladies rares du foie de l’enfant,
Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital
Bicêtre, Le Kremlin-Bicêtre, France
- Cardiologie congénitale, Institut Mutualiste Montsouris, Paris,
France
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, School of Medicine
and Surgery - University of Milano-Bicocca, Bergamo, Italy
| | - Aurélie Plessier
- ERN RARE LIVER
- Centre de référence des maladies vasculaires du foie, Service
d’hépatologie Hôpital Beaujon, Clichy, France
- VALDIG
| | - Alberto Quaglia
- Department of Cellular Pathology, Royal Free London NHS Foundation
Trust/UCL Cancer Institute, London, England
| | - Anne-Laure Rougemont
- Swiss Pediatric Liver Center, Division of Clinical Pathology, Diagnostic
Department, University of Geneva, Geneva, Switzerland
| | - Laurent Savale
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Centre de référence de l’hypertension pulmonaire, Service de
pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson,
France
- ERN Lung
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre,
France
- AP-HP, Centre de référence de l’hypertension pulmonaire, Service de
pneumologie et soins intensifs respiratoires, Hôpital Bicêtre, Le
Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson,
France
- ERN Lung
| | - Riccardo Antonio Superina
- Northwestern University Feinberg School of Medicine, Ann & Robert H.
Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and
Development, Tokyo, Japan
| | - Mirjam van Albada
- Department of paediatric and congenital cardiology, University Medical
Center Groningen, University of Groningen, The Netherlands
| | - Hubert Petrus Johannes van der Doef
- Division of paediatric gastroenterology and hepatology, Department of
paediatrics, University Medical Center Groningen, Groningen, The
Netherlands
| | - Valérie Vilgrain
- ERN RARE LIVER
- VALDIG
- Université Paris Cité, CRI, INSERM, Paris, France
- AP-HP, Département de Radiologie, Hôpital Beaujon. Nord, Clichy,
France
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of pediatrics, Gynecology and
Obstetrics, University of Geneva, Geneva, Switzerland
- Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque
Pédiatrique, University of Geneva and Lausanne, Switzerland
| | - Nitash Zwaveling
- Department of Pediatric Endocrinology, Amsterdam University Medical
Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Debray
- ERN RARE LIVER
- ERN Transplant Child
- AP-HP, Unité d’hépatologie pédiatrique et transplantation hépatique,
Hôpital Necker, Paris, France
- Centre de Référence des maladies rares du foie de l’enfant, FILFOIE,
France
| | - Barbara Elisabeth Wildhaber
- ERN RARE LIVER
- Swiss pediatric Liver Center, Division of pediatric surgery, Department
of Pediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva,
Switzerland
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Steg Saban O, Weissbach T, Achiron R, Pekar Zlotin M, Haberman Y, Anis Heusler A, Kassif E, Weiss B. Intrahepatic portosystemic shunts, from prenatal diagnosis to postnatal outcome: a retrospective study. Arch Dis Child 2023; 108:910-915. [PMID: 37474281 DOI: 10.1136/archdischild-2023-325424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Congenital intrahepatic portosystemic shunts (IHPSS) are rare vascular malformations resulting in blood bypassing the liver to the systemic circulation. Previous studies included symptomatic patients diagnosed postnatally, but the outcome of IHPSS diagnosed prenatally is rarely reported. We present a cohort of children prenatally diagnosed with IHPSS and report their natural course and outcome. METHODS AND DESIGN This was a retrospective study of all fetal cases diagnosed by ultrasound with IHPSS between 2006 and 2019 at a single tertiary centre which were prospectively followed up at the paediatric gastroenterology unit. The postnatal outcome was compared between patients with a single versus multiple intrahepatic shunts. RESULTS Twenty-six patients (70.3% boys) were included in the study, of them, eight (30.8%) patients had multiple intrahepatic shunts. The median gestational age at diagnosis was 29.5 weeks. Growth restriction affected 77% of the cohort. Postnatally, spontaneous shunt closure occurred in 96% of patients at a median age of 7.5 months (IQR 2.2-20 months). Failure to thrive (FTT) and mild developmental delay were observed in eight (30.8%) and seven (26.9%) patients, respectively. FTT was significantly more prevalent in patients with multiple shunts compared with patients with a single shunt (62.5% vs 16.7%, p=0.02); however, the rate of shunt closure and age at time of closure were similar between these groups. All patients survived with limited to no sequelae. CONCLUSIONS IHPSS usually close spontaneously by 2 years of age. Children with prenatally detected IHPSS may develop FTT and mild developmental delay. Close surveillance at a paediatric gastroenterology unit may be beneficial.
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Affiliation(s)
- Or Steg Saban
- Pediatrics B Department, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Reuven Achiron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Marina Pekar Zlotin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center Assaf Harofeh, Tzrifin, Israel
| | - Yael Haberman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Anis Heusler
- Department of OBGYN, Laniado Hospital, Netanya, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eran Kassif
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Batia Weiss
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology and Nutrition Unit, Sheba Medical Center, Tel Hashomer, Israel
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Carneiro DN, Rossi I, Oliveira NT, de Moraes Oliveira L, Rodrigues M, Araujo Júnior E, Ruano R, Peixoto AB, Paschoini MC. Congenital intra-hepatic porto-systemic shunts diagnosed during intrauterine life: Systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:803-811. [PMID: 36152014 DOI: 10.1002/jcu.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/27/2022] [Accepted: 09/03/2022] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the ultrasonographic characteristics of congenital porto-systemic venous shunts (CPSS) diagnosed during pregnancy, their outcomes, and their evolution. METHODS Two independent researchers selected 493 review articles and case reports through the analysis of titles, abstracts, and full text. The PubMed and LILACS databases were searched. Through the application of filters according to the PRISMA protocol, only six articles were used in the research. The following information was collected, when available: gestational age at diagnosis, gender, birth weight, type of shunt, associated anomalies/complications and treatment/progression. RESULTS The data were obtained from 27 cases, with 22 (82%) fetuses diagnosed with intra-hepatic CPSS and 5 (18%) with extra-hepatic CPSS. The median time of intrauterine diagnosis was 33 weeks. In 12 (57.1%) of the 21 pregnancies evaluated, delivery was preterm. The estimated fetal weight ranged from 1150 to 3760 g, with 4 (25%) cases at <3rd, 3 (18.75%) cases at <10th, 8 (50%) cases at <50th, and 1 (6.25%) case at >97th percentile for gestational age. The most frequent obstetric complication was fetal growth restriction, which occurred in nine (60%) cases. As for postnatal treatment, 19 (70.4%) cases were conservatively treated, and 8 (29.6%) cases required surgical intervention. CONCLUSION The diagnosis of CPSS still represents a challenge during prenatal care. Its early identification aims to provide guidance to pregnant women and their families, as well as follow-up and anticipation of possible complications, in addition to the evaluation of the mode of delivery and postnatal follow-up, directing the short- and long-term prognosis.
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Affiliation(s)
- Darlei Neves Carneiro
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Isabela Rossi
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Nagibe Tayfour Oliveira
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Lorena de Moraes Oliveira
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Mariana Rodrigues
- Department of Radiology and Imaging Diagnostic, Faculty of Medicine of Ribeirão Preto - University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Marina Carvalho Paschoini
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
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6
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Lu L, Yao L, Wei H, Hu J, Li D, Yin Y, Su J, Li Q, Zhu S, Tang X, Huang W, Zhu B, Zhang J. Ultrasonographic classification of 26 cases of fetal umbilical-portal-systemic venous shunts and the correlations with fetal chromosomal abnormalities. BMC Pregnancy Childbirth 2023; 23:236. [PMID: 37038108 PMCID: PMC10084610 DOI: 10.1186/s12884-023-05525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/16/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE To investigate the ultrasonographic classification of fetal umbilical-portal-systemic venous shunts (UPSVS) and the correlations with fetal chromosomal abnormalities. METHODS We retrospectively analyzed the ultrasound characteristics and the corresponding chromosomal abnormalities of 26 cases of fetal UPSVS prenatally diagnosed. RESULTS A total of 26 fetuses diagnosed as UPSVS were included, including four cases of type I UPSVS, ten of type II, three of type IIIA, and nine of type IIIB. Four cases of type I were all complicated by fetal heart enlargement and heart insufficiency, of which one case had multiple malformations, and all four cases terminated pregnancies. Six of ten cases of type II terminated pregnancies, including four of Down's syndrome, one of twin reversed arterial perfusion sequence, one of fetal edema but with normal copy number variation (CNV) by chorionic villus sampling. The other four of ten cases were isolated type II with normal chromosomes, which were delivered at full term and were normal in growth and development when followed up 34 months after birth. Three cases of type IIIA all terminated pregnancies, of which one had multiple malformations, one had right multicystic dysplastic kidney, and one had fetal heart enlargement and heart failure. Among nine of type IIIB, seven with chromosomal abnormalities and/ or complicated malformations terminated pregnancies, and two with isolated type IIIB and normal chromosomes were delivered at full term, and were normal in growth and development (one was followed up to 33 months after birth and the other 20 months after birth). CONCLUSION Fetal UPSVS can be clearly diagnosed and typed by prenatal ultrasonography. Fetal prognosis is determined by the types of UPSVS and complicated malformations and/ or chromosomal abnormalities. The probability of fetal chromosomal abnormalities in UPSVS fetuses is related to the ultrasonographic classification.
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Grants
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
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Affiliation(s)
- Lihua Lu
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, 650500, P.R. China
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
- Department of Medical Ultrasonics, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, 530021, P.R. China
| | - Limin Yao
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Hui Wei
- Department of Medical Ultrasonics, Prenatal Diagnosis Center of Guangxi Zhuang Autonomous Region, Maternity and Child Health-care Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530028, P.R. China
| | - Jilin Hu
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Dongmei Li
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Yifei Yin
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Jie Su
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Qian Li
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Shu Zhu
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Xinhua Tang
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Wenming Huang
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Baosheng Zhu
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, 650500, P.R. China
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Jinman Zhang
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, 650500, P.R. China.
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China.
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7
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Fetal Intrahepatic Umbilical-Porto-Systemic Venous Shunts (IHUPSVS): in-utero anatomic classification. Eur J Obstet Gynecol Reprod Biol 2022; 276:179-184. [PMID: 35930812 DOI: 10.1016/j.ejogrb.2022.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Congenital intrahepatic shunts divert highly oxygen and nutrients rich placental blood flow from the liver into the systemic flow having a negative influence on normal fetal growth and postnatal development. The ability to recognize this anomaly helps assess the possible clinical impact, counseling, and management of pregnancy. The present study aimed to propose in utero classification for the Intrahepatic Umbilical-Porto-Systemic Venous Shunt (IHUPSVS) based on our experience. STUDY DESIGN A prospective study. Grayscale ultrasound with two and three-dimensional high-definition Doppler modalities was used. IHUPSVS was defined as a diversion of blood from the liver tissue by abnormal communication between a branch of the intrahepatic Umbilical vein or the Portal veins with the systemic circulation (the Hepatic veins or the Sub-Diaphragmatic Vestibulum). RESULTS Twenty-five fetuses were diagnosed with IHUPSVS. We identified three main anatomic types: I) Porto-hepatic shunt which was divided into Ia) regular single shunt (15/25, 60%) and Ib) regular multiple shunts, (6/25, 24%) II) Umbilical-Porto-Hepatic shunt divided into a) Umbilical or b) Umbilical combined with Portal hepatic shunt (2/25, 8%) and III) Cavernous- aneurysmatic shunt (2/25, 8%). All the shunts were verified by postnatal targeted sonography. CONCLUSIONS This study creates the anatomic basis for common nomenclature and future probable updating for this anomaly.
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8
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Bahadori A, Kuhlmann B, Debray D, Franchi-Abella S, Wacker J, Beghetti M, Wildhaber BE, McLin VA. Presentation of Congenital Portosystemic Shunts in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020243. [PMID: 35204963 PMCID: PMC8870378 DOI: 10.3390/children9020243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/31/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Background: Congenital portosystemic shunts (CPSS) are rare vascular anomalies resulting in communications between the portal venous system and the systemic venous circulation, affecting an estimated 30,000 to 50,000 live births. CPSS can present at any age as a multi-system disease of variable severity mimicking both common and rare pediatric conditions. Case presentations: Case A: A vascular malformation was identified in the liver of a 10-year-old girl with tall stature, advanced somatic maturation, insulin resistance with hyperinsulinemia, hyperandrogenemia and transient hematuria. Work-up also suggested elevated pulmonary pressures. Case B: A young girl with trisomy 8 mosaicism with a history of neonatal hypoglycemia, transient neonatal cholestasis and tall stature presented newly increased aminotransferase levels at 6 years of age. Case C: A 3-year-old boy with speech delay, tall stature and abdominal pain underwent abdominal ultrasound (US) showing multiple liver nodules, diagnosed as liver hemangiomas by hepatic magnetic resonance imaging (MRI). Management and outcome: After identification of a venous malformation on liver Doppler US, all three patients were referred to a specialized liver center for further work-up within 12 to 18 months from diagnosis. Angio-computed tomography (CT) scan confirmed the presence of either an intrahepatic or extrahepatic CPSS with multiples liver nodules. All three had a hyperintense signal in the globus pallidus on T1 weighted cerebral MRI. Right heart catheterization confirmed pulmonary hypertension in cases A and C. Shunts were closed either using an endovascular or surgical approach. Liver nodules were either surgically removed if there was a risk of malignant degeneration or closely monitored by serial imaging when benign. Conclusion: These cases illustrate most of the common chief complaints and manifestations of CPSS. Liver Doppler US is the key to diagnosis. Considering portosystemic shunts in the diagnostic work-up of a patient with unexplained endocrine, liver, gastro-intestinal, cardiovascular, hematological, renal or neurocognitive disorder is important as prompt referral to a specialized center may significantly impact patient outcome.
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Affiliation(s)
- Atessa Bahadori
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (J.W.); (M.B.)
- Correspondence:
| | - Beatrice Kuhlmann
- Pediatric Endocrinology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Dominique Debray
- Pediatric Liver Unit, Necker Hospital, APHP, Paris Centre University, 75015 Paris, France;
| | - Stephanie Franchi-Abella
- Pediatric Radiology, Paris-Saclay University, Hôpital Bicêtre, Hôpitaux Paris-Saclay APHP, 94270 Paris, France;
| | - Julie Wacker
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (J.W.); (M.B.)
- Pulmonary Hypertension Program, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
| | - Maurice Beghetti
- Pediatric Specialties Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (J.W.); (M.B.)
- Pulmonary Hypertension Program, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
- Pediatric Cardiology Unit, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
| | - Barbara E. Wildhaber
- Swiss Pediatric Liver Center, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (B.E.W.); (V.A.M.)
- Child and Adolescent Surgery Division, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
| | - Valérie Anne McLin
- Swiss Pediatric Liver Center, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland; (B.E.W.); (V.A.M.)
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Gynecology, and Obstetrics, University Hospitals Geneva (HUG), University of Geneva, 1211 Geneva, Switzerland
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9
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Leung KY. Imaging of fetal precordial venous system by four-dimensional ultrasound with spatiotemporal image correlation technology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:193-197. [PMID: 34939684 DOI: 10.1002/jcu.23111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Despite the use of two- and three- dimensional color Doppler ultrasonography, the prenatal sonographic evaluation of precordial venous system remains difficult. Spatiotemporal image correlation (STIC) technology has been well described for the assessment of the fetal heart, but not of precordial venous system. As demonstrated in this report, it is feasible to use four-dimensional ultrasound with STIC rendered volume in glass-body mode and tomographic ultrasound imaging to image this system including the connection and drainage of the ductus venosus, hepatic veins and inferior vena cava to the fetal heart. This novel approach can increase the understanding of this venous system.
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Affiliation(s)
- Kwok-Yin Leung
- Obstetrics and Gynaecology, Gleneagles Hospital Hong Kong, Hong Kong, China
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10
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Cytter-Kuint R, Slae M, Kvyat K, Shteyer E. Characterization and natural history of congenital intrahepatic portosystemic shunts. Eur J Pediatr 2021; 180:1733-1737. [PMID: 33481107 DOI: 10.1007/s00431-021-03949-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Congenital intrahepatic portosystemic shunts are rare vascular malformations in which abnormal communications are created between the portal veins and the hepatic veins or the inferior vena cava system. Diagnosis is made by prenatal or postpartum ultrasound. Published data regarding presentation, symptoms, and prognosis is scarce. This study aimed to better understand the natural history and the course of the intrahepatic portosystemic shunts. Data were collected from children in two medical centers who were diagnosed with congenital intrahepatic portosystemic shunts on either prenatal or postnatal sonographic screening. The subjects' medical information was collected including demographics, medical background, and sonographic and clinical outcome. Blood test results including ammonia levels and liver function tests were documented, as well as the sonographic dimensions of the shunt vessels and the spleen size. The data were analyzed using various statistical methods. Twenty-three children with portosystemic shunts were found and reviewed. Eight children were excluded from the study since records and follow-up were insufficient. Fifteen patients were included in the study (six females). All had intrahepatic shunt diagnosed either by prenatal screening or postnatal abdominal ultrasound and had more than one ultrasound and repeated blood tests. Shunt closure was observed in all children within a mean of 114.31 ± 115.05 days (median 84). There was no correlation between liver enzymes, ammonia, and ultrasound vascular and splenic diameters to time to closure. None of the children had any hepatic or other sequelae.Conclusions: Our study suggests that congenital intrahepatic portosystemic shunt is a benign, self-limiting condition in which no correlation between the size of the shunt and the blood ammonia level to the outcome of the shunt was found. This is the first study that correlated radiological measures to the outcome. These results suggest that the treating physician should reassure families and conduct minimal follow-up and interventions in children with such conditions. Further, larger and prospective studies should be done to corroborate these conclusions. What is Known: • Characteristics and natural history of intrahepatic portosystemic shunts are less defined. • The natural course of the intrahepatic malformations varies, but spontaneous, self-resolution of small shunts, usually occures within 1 to 2 years. What is New: • In this study, congenital intrahepatic portosystemic shunt was shown to be benign, self-limiting condition in which all shunts closed within 3 months. • No correlation between the size of the shunt and the blood ammonia level to the outcome of the shunt was found.
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Affiliation(s)
- Ruth Cytter-Kuint
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Slae
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Gastroenterology Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Karina Kvyat
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Juliet Keidan Institute of Pediatric Gastroenterology, Pediatric Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eyal Shteyer
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,The Juliet Keidan Institute of Pediatric Gastroenterology, Pediatric Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
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11
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Prenatal 3D-ultrasound diagnosis of isolated intrahepatic portal-systemic shunt with intact ductus venosus: A case report and literature review. Radiol Case Rep 2021; 16:1173-1178. [PMID: 33796163 PMCID: PMC7995476 DOI: 10.1016/j.radcr.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022] Open
Abstract
We present a case of isolated intrahepatic portosystemic shunts with an aorto- hepatic-umbilical connection; prenatally diagnosed with 3D Doppler flow in a 27-year-old patient at 27 weeks of gestation. Fetal karyotyping was normal, detailed evaluation of the venous and cardiovascular system showed a patent ductus venosus and no other abnormalities. These fetuses with isolated intrahepatic shunts are at risk for intra-uterine growth restriction (27%), all cases had a good prognosis with live births. Postnatal follow-up to control shunt closure is vital as persistent shunts may lead to subsequent complications.
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12
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Xu S, Zhang P, Hu L, Zhou W, Cheng G. Case Report: Clinical Features of Congenital Portosystemic Shunts in the Neonatal Period. Front Pediatr 2021; 9:778791. [PMID: 34926351 PMCID: PMC8674941 DOI: 10.3389/fped.2021.778791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this single-center retrospective study was to analyze the clinical characteristics, treatment options, and course of neonatal-onset congenital portosystemic shunts (CPSS). Methods: We included all patients with CPSS who presented with clinical symptoms within the neonatal period in our institution between 2015 and 2020. Results: Sixteen patients were identified, including 13 patients with intrahepatic portosystemic shunts (IPSS) and three patients with extrahepatic portosystemic shunts (EPSS). The median age of diagnosis was 16 days (range prenatal 24 weeks-12 months). Hyperammonemia (60%), neonatal cholestasis (44%), elevated liver enzyme (40%), hypoglycemia (40%), thrombocytopenia (38%), and coagulation abnormalities (23%) appeared in neonatal CPSS. Twelve patients (75%) presented with congenital anomalies, of which congenital heart disease (CHD) (44%) was the most common. Thirteen patients with IPSS initially underwent conservative treatment, but two of them were recommended for the catheter interventional therapy and liver transplantation, respectively, due to progressive deterioration of liver function. Spontaneous closure occurred in nine patients with IPSS. The shunt was closed using transcatheter embolization in one patient with EPSS type II. Another patient with EPSS type II underwent surgical treatment of CHD firstly. The remaining patient with EPSS type Ib received medical therapy and refused liver transplantation. Conclusion: Hyperammonemia, neonatal cholestasis, elevated liver enzyme, hypoglycemia, and thrombocytopenia are the main complications of neonatal CPSS. Moreover, CPSS is associated with multiple congenital abnormalities, especially CHD. Intrahepatic portosystemic shunts may close spontaneously, and conservative treatment can be taken first. Extrahepatic portosystemic shunts should be closed to prevent complications.
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Affiliation(s)
- Suhua Xu
- Department of Neonatology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Neonatology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Liyuan Hu
- Department of Neonatology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- Department of Neonatology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guoqiang Cheng
- Department of Neonatology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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13
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Kivilevitch Z, Kassif E, Gilboa Y, Weisbuch T, Achiron R. The intra-hepatic umbilical-Porto-systemic venous shunt and fetal growth. Prenat Diagn 2020; 41:457-464. [PMID: 33340131 DOI: 10.1002/pd.5882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The fetal liver circulation has an important role in fetal growth. The intra-hepatic Umbilical-Porto-Systemic Venous Shunt (IHUPSVS) causes a reduction of the umbilical blood flow to the liver and has been reported to have a restrictive effect on fetal growth. The aim of this study was to evaluate the effect of IHUPSVS on fetal growth. METHODS We conducted a retrospective cohort study of IHUPSVS diagnosed between 2001 and 2019. IHUPSVS was defined as any abnormal communication between any branch of the portal vein and hepatic vein. Pre- and postnatal characteristics were collected from medical files and compared between cases with fetal growth restriction (FGR) and those appropriate for gestational age (AGA). RESULTS Twenty-five fetuses were included in the study. Eighteen (72%) had last estimated fetal weight and birth weight below the 10th centile, four (16%) of them between the third and fifth centile, and 11 (44%) below the third centile. Median gestational age at delivery was lower for FGR than AGA fetuses (37 vs. 38 weeks, p = 0.034) and rate of preterm delivery was higher (38.9 vs. 14.3, P = 0.24). Four cases had associated structural anomalies (2 in each group), and two had minor genetic aberrations (1 in each group). CONCLUSIONS Growth restriction is prevalent in fetuses with IHUPSVS, suggesting that fetal growth should be monitored. In equal measure, in cases with growth restriction, especially without other apparent cause, an intrahepatic shunt should be looked for.
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Affiliation(s)
- Zvi Kivilevitch
- Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer-Sheva, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Weisbuch
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Lambert V, Ladarre D, Fortas F, Durand P, Hervé P, Gonzales E, Guérin F, Savale L, McLin VA, Ackermann O, Franchi-Abella S. Cardiovascular disorders in patients with congenital portosystemic shunts: 23 years of experience in a tertiary referral centre. Arch Cardiovasc Dis 2020; 114:221-231. [PMID: 33281106 DOI: 10.1016/j.acvd.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/16/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Congenital portosystemic shunts are rare vascular malformations that may have an impact on the heart-lung system. Associated congenital and/or acquired heart diseases are poorly reported. AIMS To analyse cardiovascular disorders within a large congenital portosystemic shunt population, and develop a diagnostic strategy. METHODS Among the 168 consecutive fetuses and children referred for congenital portosystemic shunt (1996-2019), patients presenting with at least one cardiovascular disorder, including congenital heart disease, heart failure, portopulmonary hypertension and/or hepatopulmonary syndrome, were reviewed retrospectively. Cardiovascular disorders were detected using echocardiography and one or more of the following: right-sided heart catheterization; contrast-enhanced transthoracic echocardiography; or lung perfusion radionuclide scan. RESULTS Overall, 46/168 patients with a congenital portosystemic shunt (27.4%) had one or more clinically significant cardiovascular disorders. Congenital heart disease was present in 28 patients, including six with left heterotaxy. Heart failure was present in six fetuses and 21 neonates (eight without congenital heart disease, and 13 with congenital heart disease). In neonates without congenital heart disease, heart function recovered by the age of 3years. Portopulmonary hypertension was identified in 11 patients (mean age at diagnosis: 9years); it was fatal in one patient, and remained stable in five of six patients after congenital portosystemic shunt closure. In six patients, hepatopulmonary syndrome presented as hypoxia (mean age at diagnosis: 5.3years), which reversed after congenital portosystemic shunt closure. CONCLUSIONS Evaluation and monitoring of the cardiopulmonary status of patients with a congenital portosystemic shunt is mandatory to detect and prevent cardiovascular complications. Furthermore, congenital portosystemic shunts must be sought in patients with unexplained cardiovascular disorders, especially when malformations are present.
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Affiliation(s)
- Virginie Lambert
- Paediatric and Congenital Cardiology, Department of Cardiology, Institut Mutualiste Montsouris, 75014 Paris, France; Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France.
| | - Delphine Ladarre
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France
| | - Feriel Fortas
- Department of Paediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Philippe Durand
- Department of Paediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Pierre Hervé
- Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; INSERM UMR-S 1193, Paris-Saclay, 91400 Orsay, France
| | - Florent Guérin
- Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; Department of Paediatric Surgery, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; INSERM UMR-999, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Valérie A McLin
- Swiss Paediatric Liver Center, Department of Paediatrics, Gynecology and Obstetrics, European Reference Network RARE-LIVER, University Hospitals Geneva and University of Geneva Medical School, 1205 Geneva, Switzerland
| | - Oanez Ackermann
- Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Department of Paediatric Hepatology and Liver Transplantation Unit, Bicêtre Hospital, AP-HP, Paris-Saclay, 94275 Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Vasculaires du Foie (MVF), Filière de Santé des Maladies Rares du Foie de l'Enfant et de l'Adulte (FILFOIE), European Reference Network RARE-LIVER, FHU Hepatinov, Bicêtre Hospital, AP-HP, Paris-Saclay University Hospitals, 94275 Le Kremlin-Bicêtre cedex, France; BioMaps-UMR 8081, University Paris-Saclay, 91400 Orsay, France
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15
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Born M. The Ductus Venosus. ROFO-FORTSCHR RONTG 2020; 193:521-526. [PMID: 33152783 DOI: 10.1055/a-1275-0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND the ductus venosus (DV) is not well known in general radiology, but it plays a role in the daily work of pediatric radiologists. Consequently all general radiologists who also care for a pediatric department should be familiar with the physiological and pathological findings related to the DV. METHODS Literature research in Medline, using the keywords "ductus venosus" and "umbilical vein catheter". RESULTS AND CONCLUSIONS In the first weeks of life the DV is regularly still patent. It should be recognized as DV and not be mistaken for a pathological portosystemic shunt.The ductus venosus is the lead structure for umbilical vein catheters. Radiologists should be able to assess the correct catheter position. Radiologically important findings of an umbilical vein catheter are mainly malposition and intrahepatic extravasation. Agenesis of the DV can lead to intra- or extrahepatic compensatory portosystemic shunts, in which as well as in the case of persistent patency of the DV, there may be the necessity for radiological-interventional or surgical occlusion. KEY POINTS · In the first weeks of life in infants the Ductus venosus is regularly still patent.. · The Ductus venosus should not be mistaken for a pathological portosystemic shunt.. · An umbilcal vein catheter should project onto the Ductus venosus and end caudal to the right atrium.. · Intrahepatic portosystemic shunts in DV agenesis show a high rate of spontaneous closure postnatally.. CITATION FORMAT · Born M. The Ductus Venosus. Fortschr Röntgenstr 2021; 193: 521 - 526.
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Affiliation(s)
- Markus Born
- Department of Radiology, Division of Pediatric Radiology, University Hospital Bonn, Germany
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Demirci O, Akay HÖ. Prenatal diagnosis of abnormality of the umbilical portal DV complex: difficulty in universal classification due to various alternative routes in hepatic circulation for placental drainage. J Matern Fetal Neonatal Med 2020; 35:3872-3884. [PMID: 33138669 DOI: 10.1080/14767058.2020.1842870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review our experience with fetal abnormality of the umbilical-portal-DV complex and to discuss the new classification system for umbilical portal systemic venous shunts (UPSVS) according to our cases. METHODS This study was a retrospective analysis of fetuses with a prenatal diagnosis of abnormality of the umbilical-portal-DV complex. The integrity of the fetal umbilical-portal ductus venosus complex and the hepatic venous system were evaluated using two-dimensional color Doppler sonography. The origin of the shunt, the location of the drainage, and the presence or absence of intrahepatic portal venous system and DV were noted. RESULTS 35 cases of abnormality of the umbilical-portal-DV complex were identified. Agenesis of ductus venous was detected in 33 of them. Based on the abnormality of the umbilical-portal-DV complex, we divided the cases into five groups. Group 1, ductus venosus agenesis with normal hepatic venous anatomy (n = 11); Group 2 downward displacement of the umbilical-portal-DV complex (n = 13); Group 3, umbilical-systemic shunt (n = 5); Group 4, intrahepatic portosystemic shunt (n = 4), Group 5, hepatic arteriovenous malformation (n = 2). Three different intrahepatic portosystemic shunt and one different downward displacement of the umbilical-portal-DV complex cases were detected. CONCLUSIONS Disruption of the normal anatomy of the umbilical-portal-DV complex causes various alternative pathway of the placental drainage. This illustrates highlights the challenge of creating a universal classification.
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Affiliation(s)
- Oya Demirci
- The Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Mreish S, Hamdan MA. Pre and postnatal diagnosis of congenital portosystemic shunt: Impact of interventional therapy. Int J Pediatr Adolesc Med 2020; 7:127-131. [PMID: 33094141 PMCID: PMC7567999 DOI: 10.1016/j.ijpam.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Congenital portosystemic shunts (CPSS) are rare vascular malformations that can lead to severe complications. With advanced imaging techniques, diagnosis is becoming more feasible occurring in fetal life. Different approaches have been adopted to manage these cases, with an increased utilization of interventional therapy recently. This cohort aims to describe the course of children diagnosed with CPSS and the impact of interventional therapy on the outcome. METHODS Retrospective chart review was done for all patients who were diagnosed with CPSS in our institution between January 2006 and December 2015. RESULTS Six patients were diagnosed with CPSS. During this period, 8,680 mothers carrying 9548 fetuses underwent fetal ultrasound examinations. Three patients were diagnosed antenatally at a median [IQ] gestational age of 33 [26-33] weeks, and three patients were diagnosed postnatally at 0, 2, and 43 months, respectively. At a median follow-up of 87 [74-110] months, 5 patients are alive; 4 of whom had received transcatheter closure for different indications, and one who had spontaneous resolution of her CPSS. One infant died at the age of 6 weeks secondary to sepsis. CONCLUSION CPSS can result in significant complications in children. Interventional therapy is feasible at any age group, but long-term follow-up is warranted.
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Affiliation(s)
- Shireen Mreish
- Pediatrics, Tawam Hospital, Affiliated with Johns Hopkins, Al Ain, United Arab Emirates
| | - Mohamed A. Hamdan
- Pediatric Cardiology, KidsHeart Medical Center, Dubai, United Arab Emirates
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Wang Y, Yan Y, Yang Z, Wei J, Liu G, Pei Q. Prenatal diagnosis of congenital portosystemic shunt: A single-center study. J Obstet Gynaecol Res 2020; 46:1988-1993. [PMID: 32761766 DOI: 10.1111/jog.14403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/07/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
AIM To review our experience with the prenatal diagnosis of congenital portosystemic shunt (CPSS). METHODS This is a retrospective study of CPSS cases examined at an ultrasonographic tertiary referral center from 2013 to 2019. The anatomical origin and drainage of the shunt were assessed. Feto-maternal clinical characteristics and long-term outcomes were investigated via medical files and telephone interviews with the mothers. RESULTS Eleven cases were reviewed. Based on the anatomical origins, before or after portal vein division, cases were classified into extrahepatic portosystemic shunt (EHPSS, n = 3, 27.3%) and intrahepatic portosystemic shunt (IHPSS, n = 8, 72.7%). Additional abnormalities were also observed in the EHPSS (n = 2, 66.7%) and IHPSS (n = 3, 37.5%) groups. Intrauterine growth restriction was the most common abnormality (n = 4, 80%). The median age of the pregnant women was 31.9 years (range 26 ~ 43 years). Most cases (n = 8, 72.7%) were diagnosed in the third trimester, and the median gestational age was 31+5 weeks (range 24 ~ 36+6 weeks). Three cases underwent karyotype examinations, and one had trisomy 13. The median time after birth was 2 years (range 0.7 ~ 5.7 years). The overall postnatal live-birth rate was 60% (6/10), not including one case with no data on pregnancy outcome. The mothers of the six live births indicated that their children were in excellent health. CONCLUSION This study indicates that prenatal CPSS diagnosis is feasible, especially in the third trimester. IHPSS is more common than EHPSS. Complicated cases most often occur with EHPSS. Intrauterine growth restriction is the most common concomitant abnormality. The prognosis of most cases is good.
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Affiliation(s)
- Yan Wang
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yani Yan
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Zhenjuan Yang
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Jun Wei
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Guoli Liu
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Qiuyan Pei
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
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Wu Y, Zhou L, Chen L. Correlations among Congenital Hepatic Shunt, Absent Ductus Venosus, and Umbilical Vein Shunt Revealed by Prenatal Ultrasound. Fetal Diagn Ther 2019; 47:237-244. [PMID: 31553987 DOI: 10.1159/000502182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Congenital disruptions of the hepatic vasculature such as hepatic vascular shunt and absence of ductus venosus (ADV) are rare and often asymptomatic. Moreover, hepatic vasculature abnormality, ADV, and umbilical shunt are easily missed during ultrasound screening due to insufficient scope of examination. In our study, we analyzed the associations among congenital hepatic shunt, ADV, and umbilical vein (UV) shunt by prenatal ultrasound screening. METHODS This was a retrospective study of 9 cases of congenital hepatic vascular shunt and 14 cases of isolated ADV identified by prenatal ultrasound screening at Chengdu Women and Children's Center Hospital from 2014 to 2018. The review parameters included ultrasound findings of the fetal hepatic vessels, fetal heart, UV, other malformations, complications, and fetal prognosis. RESULTS The 9 cases of hepatic shunt included 6 cases of isolated portosystemic shunt, 2 mixed cases of vascular shunt with portosystemic shunt, and 1 case of intrahepatic arteriovenous fistula. Among the 8 total cases of portosystemic shunt, 5 were accompanied by ADV (62.5%). Of the 5 cases of congenital hepatic shunt with ADV, 3 were accompanied by umbilical shunt (60%). Among the 9 cases of hepatic vascular shunt, 6 were accompanied by dilated inferior vena cava and cardiomegaly (66.7%). Of the 19 total ADV cases identified, there were 14 cases without hepatic shunt, 5 with hepatic shunt, and 17 with umbilical shunt (89.4%). Among the 14 ADV cases without hepatic shunt, there were 5 cases with congenital heart defect (35.7%) and 4 with cardiomegaly (28.6%). CONCLUSIONS Portosystemic shunt, ADV, and umbilical shunt are closely associated. Appreciation of these associations can improve prenatal ultrasound screening for a timely prognosis and initiation of appropriate treatment.
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Affiliation(s)
- Yun Wu
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Liuying Zhou
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China,
| | - Lin Chen
- Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China
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Plut D, Gorjanc T. A case of a newborn with an intrahepatic congenital portosystemic venous shunt with concurrent congenital duodenal web. Acta Radiol Open 2019; 8:2058460119854173. [PMID: 31218081 PMCID: PMC6563404 DOI: 10.1177/2058460119854173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Intrahepatic congenital portosystemic venous shunts are rare vascular anomalies. We report a unique case of a neonate with an intrahepatic congenital portosystemic venous shunt with concurrent congenital duodenal web. Such association has not been previously reported to our knowledge. Interestingly, the shunt became apparent on the seventh day, after a delayed start of oral feeding due to the neonate’s recovery from the duodenal web surgery. The shunt was small and the clinical symptomatology mild. No direct treatment was required. The laboratory and the ultrasound follow-up of the child noted a spontaneous resolution of the shunt by the age of six months.
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Affiliation(s)
- Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Wu H, Tao G, Cong X, Li Q, Zhang J, Ma Z, Zhang Z. Prenatal sonographic characteristics and postnatal outcomes of umbilical-portal-systemic venous shunts under the new in-utero classification: A retrospective study. Medicine (Baltimore) 2019; 98:e14125. [PMID: 30633228 PMCID: PMC6336581 DOI: 10.1097/md.0000000000014125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An in-utero re-classification of umbilical-portal-systemic venous shunt (UPSVS) has recently been proposed. We retrospectively reviewed the sonograms of a large cohort of fetuses, identified and analyzed UPSVS cases, and presented the prenatal sonographic characteristics, birth outcomes, and follow-up results following the new classification system.Sonograms and clinical data of all participants who visited our departments from April 2016 to July 2018 were retrospectively reviewed. Identified cases of UPSVS were analyzed according to the new classification: Type I: umbilical-systemic shunt (USS); Type II: ductus venosus-systemic shunt (DVSS); Type IIIa: intrahepatic portal-systemic shunt (IHPSS) and Type IIIb: extrahepatic portal-systemic shunt (EHPSS). Postnatal follow-ups ranged from 3 months to 1 year.A total of 10 UPSVS cases were identified in 61,082 fetuses: 4 with Type I, 3 with Type II and 3 with Type IIIa. All 4 cases of USS had complete agenesis of the portal venous system, and had the umbilical vein drained into the inferior vena cava. Two USS cases also had trisomy 21. Pregnancy was terminated in all cases with a Type I shunt. Two fetuses with DVSS had normal portal venous system and were born full term. The pregnancy of 1 DVSS case was terminated due to the detection of trisomy 21. Three cases were IHPSS with full-term birth. One had chromosomal abnormality and 1 had surgery to repair the shunt 12-days post birth. In the 2 cases that did not receive repair surgery, sonographic examination revealed the portal-hepatic venous shunt was not closed at the 6-month follow-up period. However, the 1 case that had repair surgery appeared healthy at the 3-month follow-up period.UPSVS is extremely rare. Type I shunts have the poorest prognosis, and the presence of the intrahepatic portal venous system is key to live birth in UPSVS regardless of types. Chromosomal abnormalities and other organ anomalies can occur in any types of UPSVS. Therefore, karyotyping and examination of other organs should be performed once UPSVS is detected.
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Affiliation(s)
- Haifang Wu
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Guowei Tao
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Xiang Cong
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Qi Li
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
- Medical School of Shandong University, Jinan
| | - Jing Zhang
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
- Medical School of Shandong University, Jinan
| | - Zhe Ma
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Zhonglu Zhang
- Department of Ultrasound, the Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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Douhnai D, Tassin M, Sibiude J, Franchi-Abella S, Ackermann O, Mandelbrot L, Picone O. Prenatal diagnosis of intra hepatic arterio venous fistula: case report and review of the literature. J Matern Fetal Neonatal Med 2018; 32:2575-2578. [PMID: 29463138 DOI: 10.1080/14767058.2018.1438400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To describe the prenatal features and management of a congenital intra hepatic fistula. MATERIAL AND METHODS Case report Results: Congenital intra hepatic fistula are extremely rare. The prenatal ultrasound seiology is described. CONCLUSION Prenatal diagnosis of these anomalies may improve pre and post natal management.
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Affiliation(s)
- Daria Douhnai
- a Service Gynécologie Obstétrique , Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique: Hôpitaux de Paris, Université Paris Diderot , Colombes CEDEX, France.,b DHU Risques et Grossesse , Paris , France
| | - Mikael Tassin
- a Service Gynécologie Obstétrique , Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique: Hôpitaux de Paris, Université Paris Diderot , Colombes CEDEX, France.,b DHU Risques et Grossesse , Paris , France
| | - Jeanne Sibiude
- a Service Gynécologie Obstétrique , Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique: Hôpitaux de Paris, Université Paris Diderot , Colombes CEDEX, France.,b DHU Risques et Grossesse , Paris , France
| | - Stephanie Franchi-Abella
- c Service de Radiologie pédiatrique , Hôpital Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance Publique: Hôpitaux de Paris, Université , Le Kremlin Bicêtre , France.,d DHU Hepatinov , Paris , France.,e CPDPN Bicêtre-Béclère, Hôpitaux Universiatires Paris-Sud , Le Kremlin Bicêtre , France
| | - Oanez Ackermann
- e CPDPN Bicêtre-Béclère, Hôpitaux Universiatires Paris-Sud , Le Kremlin Bicêtre , France.,f Service d'hépatopédiatrie, Centre de référence de l'atrésie des voies biliaires Hôpital Bicêtre , Hôpitaux universitaires Paris-Sud, Assistance Publique: Hôpitaux de Paris, Université , Le Kremlin Bicêtre , France
| | - Laurent Mandelbrot
- a Service Gynécologie Obstétrique , Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique: Hôpitaux de Paris, Université Paris Diderot , Colombes CEDEX, France.,b DHU Risques et Grossesse , Paris , France
| | - Olivier Picone
- a Service Gynécologie Obstétrique , Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique: Hôpitaux de Paris, Université Paris Diderot , Colombes CEDEX, France.,b DHU Risques et Grossesse , Paris , France
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Francois B, Gottrand F, Lachaux A, Boyer C, Benoit B, De Smet S. Outcome of intrahepatic portosystemic shunt diagnosed prenatally. Eur J Pediatr 2017; 176:1613-1618. [PMID: 28913555 DOI: 10.1007/s00431-017-3013-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 12/23/2022]
Abstract
UNLABELLED We analyzed the characteristics of the population with congenital portosystemic shunt diagnosed during the antenatal period and the organization of their perinatal care. This multicentric retrospective study included all the patients with a prenatal diagnosis of congenital portosystemic shunt. Between 1999 and 2015, 12 patients were included. Prenatal diagnosis was done at a median 26.5 weeks of gestation (21-34). All the patients presented intrahepatic CPSS, three of them had associated congenital cardiopathy, and one a Bannayan-Zonana syndrome. Ten patients had simple outcome on conservative treatment, eight of them having a spontaneous closure of their portosystemic shunt within the first 2 years of life. One patient had surgical treatment which failed and he developed a focal nodular hyperplasia. Another patient had radiological interventional closure of his shunt which was complicated by a venal portal thrombosis. CONCLUSION Outcome of intrahepatic portosystemic shunt diagnosed prenatally is good in the majority of cases. What is known: • Multiples studies exist on congenital porto systemic shunt but when the diagnosis is done after birth. • The evolution, management, and complication are well known. What is new: • There is very few studies with only patients diagnosed in antenatal and it is a large series of cases. • Outcome of intrahepatic portosystemic shunt diagnosed prenatally is good in the majority of cases.
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Affiliation(s)
| | - Fréderic Gottrand
- Service d'hépatologie gastro-entérologie et nutrition pédiatrique du CHRU de Lille, Lille, France
| | - Alain Lachaux
- Service d'hépatologie gastro-entérologie et nutrition pédiatrique du CHU de Lyon, Bron Cedex, France
| | - Corinne Boyer
- Service de radiologie pédiatrique des Hôpital Lenval, CHU de Nice, Nice, France
| | - Bernard Benoit
- Service maternité du Centre Hospitalier Princesse Grace, Monaco-Ville, Monaco
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Francois B, Lachaux A, Gottrand F, De Smet S. Prenatally diagnosed congenital portosystemic shunts. J Matern Fetal Neonatal Med 2017; 31:1364-1368. [DOI: 10.1080/14767058.2017.1315093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bérengère Francois
- Service de réanimation néonatale, Hôpital Archet, CHU de Nice, Nice, France
| | - Alain Lachaux
- Service d’hépatologie, gastro-entérologie et nutrition pédiatrique, Hôpital Femme-Mère-Enfant, CHU Lyon, Lyon, France
| | - Fréderic Gottrand
- Service d’hépatologie, gastro-entérologie et nutrition pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France
| | - Stéphanie De Smet
- Service de réanimation néonatale, Hôpital Archet, CHU de Nice, Nice, France
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Congenital intrahepatic portosystemic shunt diagnosed during intrauterine life. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27133713 PMCID: PMC5178127 DOI: 10.1016/j.rppede.2016.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Achiron R, Kivilevitch Z. Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:739-747. [PMID: 25988346 DOI: 10.1002/uog.14906] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/10/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To review our experience with fetal umbilical-portal-systemic venous shunts (UPSVS), to devise an in-utero classification system, and to analyze their clinical and prognostic characteristics. METHODS This was a retrospective review of cases of UPSVS examined at an academic tertiary referral center over the 14-year period from 2001 to 2014 inclusive. The anatomical origin and drainage of the fetal umbilical, portal, ductus venosus and hepatic venous systems, and the integrity of the intrahepatic portal venous system (IHPVS), were assessed using two- and three-dimensional color Doppler sonography. Fetomaternal clinical characteristics and long-term outcome were investigated by means of medical files, imaging documentation and telephone interviews with the mothers. RESULTS Forty-four cases with UPSVS were reviewed. Prenatal classification was based on the anatomical origin of the shunt (umbilical, portal or ductal), with cases classified into four types: Type I, umbilical-systemic shunt (n = 9 (20.4%)); Type II, ductus venosus-systemic shunt (n = 19 (43.2%)); and Type III, portal-systemic shunt, divided into two subtypes: Type IIIa, intrahepatic portal-systemic shunt (n = 12 (27.2%)) and Type IIIb, extrahepatic portal-systemic shunt (n = 4 (9.1%)). Each type presented particular clinical and prognostic characteristics. The most important favorable prognostic factors were absence of associated major malformation and presence of the IHPVS. Thus, Type IIIa (intrahepatic portal-systemic shunt) had the best outcome. CONCLUSIONS Fetal UPSVS are anomalies with a broad spectrum of manifestations and prognoses. Accurate mapping of the IHPVS is paramount for optimizing prenatal counseling and postnatal care. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Achiron
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Kivilevitch
- Maccabi Health Services, Ultrasound Unit, Negev Medical Center, Be'er Sheva, Israel
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Bellettini CV, Wagner R, Sette Balzanelo A, de Souza Andretta AL, Nascimento de Moura A, Fabris CC, Maranhão Gubert E. Congenital intrahepatic portosystemic shunt diagnosed during intrauterine life. REVISTA PAULISTA DE PEDIATRIA 2016; 34:384-7. [PMID: 27133713 DOI: 10.1016/j.rpped.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report a patient with prenatal diagnosis of portosystemic shunt; a rare condition in humans. CASE DESCRIPTION 17-day-old female infant admitted for investigation of suspected diagnosis of portosystemic shunt, presumed in obstetric ultrasound. The hypothesis was confirmed after abdominal angiography and liver Doppler. Other tests such as echocardiography and electroencephalogram were performed to investigate possible co-morbidities or associated complications, and were normal. We chose conservative shunt treatment, as there were no disease-related complications and this was intrahepatic shunt, which could close spontaneously by the age of 2 years. COMMENTS Portosystemic shunt can lead to various complications such as hepatic encephalopathy, hypergalactosemia, liver tumors, and hepatopulmonary syndrome. Most diagnoses are done after one month of age, after such complications occur. The prenatal diagnosis of this patient provided greater security for the clinical picture management, as well as regular monitoring, which allows the anticipation of possible complications and perform interventional procedures when needed.
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