Normal and respiratory variations of the hepatic and portal venous duplex Doppler waveforms with simultaneous electrocardiographic correlation

Abstract

To understand hepatic vein (HV) and portal vein (PV) duplex waveforms and their normal and respiratory variations, HV and PV duplex sonography with simultaneous electrocardiograpy was performed on 11 volunteers. Absolute velocities of the waveforms' components and their ratios were determined at mid· in· spiration, full inspiration, full expiration, and Valsalva maneuver. The normal HV waveform was variable in shape and component velocities and ratios but essentially consisted sequentially of (1) an antegrade systolic wave resulting from movement of the tricuspid annu• lus toward the cardiac apex and occurring shortly after QRS; (2) a retrograde v-wave resulting from atrial overfilling and occurring immediately after the T · wave; (3) an antegrade diastolic wave resulting from opening of the tricuspid valve and occurring shortly after the T-wave; and (4) a retrograde a· wave resulting from N ormal hepatic vein (HV) and portal vein (PV) duplex Doppler waveforms show cyclic phasicity that is more prominent in the HV. The nature of these waveforms is not well understood by most radiologists, and it is unclear even in the sono~ graphic literature whether this phasicity is cardiac or respiratory in origin.,_, It also has been shown that tricuspid regurgitation and diffuse hepatocellular disease can affect the shape of these duplex Doppler atrial contraction and occurring immediately after the P-wave. The ratio of the maximum systolic velocity to maximum diastolic velocity varied from 1.0 to 2.8 (mean 1.4). Systolic-to-diastolic ratio decreased during inspiration but was always greater than 0.6 and increased during expiration. The Valsalva maneuver di~ minished waveform pulsatility. PV waveforms were more triphasic than biphasic but less pulsatile, flow was totally antegrade, and respiratory changes were less remarkable than HV waveforms. All normal HV and most normal PV waveforms showed multiphasic· ity that corresponded to cyclic cardiac changes. The shapes of these waveforms were variable and were modified by respiratory movements. KEY WORDS: Liver, duplex; Hepatic and portal veins, Doppler flow varia· tions.waveforms by changing the velocities of their various components and their velocity ratios.M Because liver dysfunction can be the initial manifestation of some of these diseases, radiologists are in a position to make a specific diagnosis from the changes that occur in the shape and velocity ratios of these waveforms. However, they must first be familiar with the various components of the normal waveforms, their ratios, and their normal and respiratory variations.The purposes of this study were (1) to illustrate the Received October 2 .• 1991; from the Department of Radiology, nature of the various components of the normal HV

Terrestrial locomotion does not constrain venous return in the American alligator,Alligator mississippiensis

“…Contraction of the abdominal muscles during expiration aids venous return in mammals (Abel and Waldhausen, 1969;Youmans et al, 1963). In contrast to the inspiratory increase in IAP, intrathoracic and right atrial pressures decrease during inspiration in mammals, increasing blood flow in the veins located near the thorax, such as the jugular and hepatic veins and the superior vena cava (Abu-Yousef, 1992;Brecher and Hubay, 1955;Brecher and Mixter, 1953;Mixter, 1953;Moreno et al, 1967;Osada et al, 2002;Takata et al, 1992;Teichgraber et al, 1997;Willeput et al, 1984).…”

Effects of Respiration and Gravity on Infradiaphragmatic Venous Flow in Normal and Fontan Patients

“…The portal flow signal was obtained in the main portal trunk before its division into the right and left branches according to previously published protocols. 8 …”

“…7 Normal PV flow profile is less well understood. 8 Because of the interposed liver, portal venous flow is not in phase with the cardiac cycle and is more influenced by respiration (Figure 1). Like Arisawa et al, 7 we found increased pulsatility in both APC and TCPC groups.…”

Hepatic vein waveforms in liver cirrhosis re-evaluated

“…The phasicity is caused by the changes in cardiac cycle, predominantly the change in right atrial pressure [5]. Its correlation with electrocardiographic tracing further advocates cardiac origin.…”

“…However, change of waveform to biphasic from triphasic seems suggestive of some changes in the liver parenchyma as only cirrhotic patients showed change from triphasic to biphasic or flat waveform. Although the phasicity is cardiac in origin, respiratory motion can alter the HV waveforms and its components [5]. With Valsalva maneuver and suspended respiration, the negative oscillation disappeared in few cases and it may be the reason of discrepancy in findings among many studies.…”