Pulsatile portal vein flow: a sign of tricuspid regurgitation on duplex Doppler sonography.

Abu‐Yousef, Monzer M.; Milam, Sarah; Farner, R M

doi:10.2214/ajr.155.4.2119108

Cited by 60 publications

(29 citation statements)

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“…4 None of these changes was observed in our volunteers. It has also been shown that diffuse hepatocellular disease and the Budd-Chiari syndrome J Ultrasound Med 11: [263][264][265][266][267][268]1992 cause loss of pulsatility in the HV and inferior vena cava not unlike those seen with the Valsalva maneuver in some of the volunteers in our study.…”

Section: Discussionmentioning

confidence: 66%

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

Abu‐Yousef

1992

Journal of Ultrasound in Medicine

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101

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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

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Section: Discussionmentioning

confidence: 66%

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

Abu‐Yousef

1992

Journal of Ultrasound in Medicine

Self Cite

101

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“…He analyzed the pulsatile portal venous waveform in which minimum velocity dropped to or below zero on Doppler and investigated its possible association with TR. At the end of the study he showed that detection of a pulsatile portal venous waveform on Doppler in patients with liver dysfunction should raise the possibility of TR (26) . This finding is also comparable to the work of Loperfido, et al 1993 who studied Portal and hepatic vein flow-velocity profiles by pulsed Doppler in patients with TR and normal subjects to determine if portal vein flow analysis is useful in the evaluation of TR.…”

Section: Discussionmentioning

confidence: 99%

Changes of Portal Flow in Patients with an Acute Exacerbation of Heart Failure and Liver Congestion

Zaghla¹,

Sabawy²,

Gomma³

et al. 2015

JMSCR

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“…[30][31][32] As is widely appreciated, right atrial motion has little effect on portal vein flow in healthy individuals because the hepatic sinusoid provides adequate buffering against the marked phasic pressure changes transmitted from the right heart. However, if the systemic venous pressure is stronger than the buffering capacity, portal inflow can be interfered with and dampened.…”

Section: Discussionmentioning

confidence: 99%

Hepatofugal Portal Venous Flow on Doppler Sonography After Liver Transplantation

Jeong

Kim

Lee

et al. 2012

Journal of Ultrasound in Medicine

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Objectives The purpose of this study was to categorize hepatofugal portal venous flow on Doppler sonography after liver transplantation and to investigate its clinical importance and presumed causes based on radiologic and pathologic findings. Methods This retrospective study was approved by our Institutional Review Board, and the requirement for informed consent was waived. Examination of our database over 4 years revealed 30 patients in whom Doppler sonography showed hepatofugal portal venous flow during follow‐up periods. We investigated its occurrence and clinical features, including radiologic and pathologic findings, and classified the possible causes into 5 types: A, systemic problems; B, gross vascular abnormalities correctable by intervention; C, specific cardiac problems; D, microscopic abnormalities of the graft; and E, miscellaneous. We classified the patterns of hepatofugal portal venous flow into continuous hepatofugal or hepatofugal‐dominant to‐and‐fro flow and hepatopetal‐dominant to‐and‐fro flow, and we investigated the relationship of the presumed causes and flow patterns with the clinical course. Results The incidence of hepatofugal portal venous flow was 2.38%. The overall mortality rate was 26.67% (95% confidence interval, 11.1%–42.9%): all patients (n = 5) in group A, 1 in group C, and 2 in group D, died. Possible cause type B and a mainly hepatopetal flow pattern were good prognostic factors (P = .031 and .018, respectively). Conclusions Hepatofugal portal venous flow reflects diverse pathologic conditions after liver transplantation, and its clinical importance also differs depending on the cause.

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Pulsatile portal vein flow: a sign of tricuspid regurgitation on duplex Doppler sonography.

Cited by 60 publications

References 0 publications

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

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

Changes of Portal Flow in Patients with an Acute Exacerbation of Heart Failure and Liver Congestion

Hepatofugal Portal Venous Flow on Doppler Sonography After Liver Transplantation

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