Ductus venosus shunting in the fetal venous circulation: regulatory mechanisms, diagnostic methods and medical importance

Tchirikov, M; Schröder, Helmut; Hecher, Kurt

doi:10.1002/uog.2747

Cited by 87 publications

(78 citation statements)

References 65 publications

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“…We also encountered every low weigh gain in IUGR fetuses below 28 weeks' gestational age in spite of daily intraumbilical AA/glucose supplementation of 41.3 mL/kg/day on average (Table 1A). Chronic hypoxia of IUGR fetuses leads to the ductus venosus sparing with severe reduction of umbilical blood perfusion of the fetal liver [18]. It is generally accepted that the fetal liver produces proteins, lipids and carbohydrates involved in their metabolism [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…We speculate that the IUGR occurring in extremely preterm fetuses, below 28 weeks of gestation is harder to overcome with our protocol due to the functional limitations of the fetal liver, combined with blood flow by-pass through the DV. The ductus venosus sparing would result in significantly reduced umbilical blood perfusion of the fetal liver and could be an additional key towards the understanding of some methodological Brought to you by | Nazarbayev University Authenticated Download Date | 6/5/18 11:42 AM restrictions of AA/glucose intraumbilical supplementations [18].…”

Section: Discussionmentioning

confidence: 99%

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The effect of intraumbilical fetal nutrition via subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses

Winarno

Bapayeva

Bergner

et al. 2015

Geburtshilfe Frauenheilkd

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Objective: To determine if intrauterine intraumbilical supplementation with amino acids (AA) and glucose can improve neonatal outcome of severe growth restricted human fetuses (IUGR). Methods: Prospective pilot study of intrauterine treatment of severe IUGR fetuses [n = 14, 27 weeks of gestation (range 23-31)] with cerebroplacental ratio < 1, with longterm intraumbilical AA and glucose supplementation (10% of feto-placental blood volume/day) using a perinatal port system alone (n = 5) or combined with hyperbaric oxygenation (n = 1, HBO) vs. control group (n = 8). Results:The duration of continuous intraumbilical AA/ glucose supplementation was 11 (6-13) days. Daily intravascular fetal nutrition significantly prolonged the brain sparing to delivery interval by 24 (14-33) days vs. 5.6 (2-12) days in controls. Fetal nutrition reduced blood flow resistance in the placental circulation but did not affect the Doppler profile of cerebral arteries. Higher weight gain of 113.5 (36-539) g was observed following supplementation compared to 33.3 (8-98) g in the control group (P< 0.05). In spite of this, fetuses below 28 weeks of gestation did not sufficiently benefit from infused commercial AA. We found a reduced fetal plasma concentration of the essential AA histidine, threonine, lysine and arginine, and non-essential AA taurine, in severe IUGR fetuses in both groups. Longterm supplementation with a commercial AA formula led to a slight, but not significant, reduction of histidine, threonine, lysine, arginine, asparagine and glutamine. However, the concentration of tryptophan and glutamic acid slightly increased. HBO can be combined with AA supplementation via a port system. In one case, the port system was also successfully used for fetal blood transfusion. Conclusions: Intravascular treatment of IUGR with fetal nutrition can prolong pregnancy with severe placental insufficiency and brain sparing for many weeks. However, rather than normalizing AA concentrations, an enhanced AA imbalance was observed in IUGR fetuses following supplementation. These deviations in AA concentrations prevent the recommendation for use of commercial AA solutions for prenatal treatment of extreme preterm IUGR fetuses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of intraumbilical fetal nutrition via subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses

Winarno

Bapayeva

Bergner

et al. 2015

Geburtshilfe Frauenheilkd

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“…Sin embargo, si la invasión umbilical permanece por tiempo indefinido, por vía ascendente o por contaminación, el conducto se infecta y ulteriormente, en vez de ser émbolos estériles se convierten en émbolos sépticos que migraran hacia la circulación venosa hepática (como sucedió en el caso que presentamos) y de lo que ya existe constancia en la literatura especializada. 1 Como fundamento de la hipótesis sabemos, según lo publicado por Tchirikov y sus colaboradores, 10 que la circulación venosa umbilical, previa a la ligadura del cordón, es tan eficiente que el conducto venoso de Arancio, mediante su capacidad contráctil, mantiene bajo control la presión intravascular de la vena umbilical. Asimismo, el esfínter controla la cantidad de sangre que atraviesa las sinusoides hepáticas y es determinante para que, inmediato a la ligadura del cordón, el conducto de Arancio se ocluya de manera espontánea.…”

Section: Análisisunclassified

Onfalopileflebitis y absceso hepático neonatal

Baeza-Herrera¹,

López-Medina²,

Nájera-Garduño³

et al. 2015

Acta Pediatr Mex

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www.actapediatrica.org.mx caso clínico dE intErés EspEcial Acta Pediatr Mex 2015;36:177-181. Onfalopileflebitis y absceso hepático neonatalOmphalopylephlebitis and neonatal hepatic abscess RESUMENLa onfalopileflebitis y el absceso hepático en neonatos son raros y se asocian, en la mayoría de las ocasiones, con infecciones por Staphylococcus epidermidis y como complicación de la cateterización venosa umbilical. La manifestación única es una infección sistémica e implica dificultades diagnósticas. Presentamos los hallazgos clínicos y quirúr-gicos de un recién nacido masculino de 12 días con onfalopileflebitis y absceso hepático asociados con cateterización de la vena umbilical. ABSTRACTOmphalopylephlebitis and hepatic abscess in neonates are rare conditions mostly associated with Staphylococcus epidermidis infection and constitutes a complication of umbilical venous catheterization. The systemic infection is associated to diagnostic difficulties. We present the clinical and surgical findings of a twelve days male newborn patient with omphalopylephlebitis and hepatic abscess associated to umbilical vein catheterization.

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“…The physiological importance of the acceleration of blood is observed in intrauterine growth-restricted fetuses, in which there is increased shunting of umbilical blood flow toward the DV. This blood should be maintained in a specific location within the IVC for preferential supply of oxygen and nutrients to the myocardium and the fetal brain 9,10 . In conclusion, in the fetal IVC, cranial to the junction with the DV, high-oxygenated blood from the umbilical vein does not mix with low-oxygenated blood from the lower part of the fetal body, with each stream occupying a defined part inside the vessel.…”

Section: Umbilical Vein Injectionsmentioning

confidence: 99%

Blood‐flow streams in the fetal inferior vena cava: experimental animal study using ultrasound contrast agent

Hernández‐Andrade

Jansson

Lingman

et al. 2014

Ultrasound in Obstet & Gyne

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Ductus venosus shunting in the fetal venous circulation: regulatory mechanisms, diagnostic methods and medical importance

Abstract: K E Y W O R D S:

Cited by 87 publications

References 65 publications

The effect of intraumbilical fetal nutrition via subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses

The effect of intraumbilical fetal nutrition via subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses

Onfalopileflebitis y absceso hepático neonatal

Blood‐flow streams in the fetal inferior vena cava: experimental animal study using ultrasound contrast agent

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