Reat-time inferior vena caval ultrasonography: normal and abnormal findings and its use in assessing right-heart function.

Abstract

SUMMARY We studied the inferior vena cava (IVC) as an index of right-heart function in 111 patients. A two-dimensional echocardiographic sector was used to visualize the IVC, and its M-mode cursor was used to generate a time-motion record of the IVC size and pulsation. Normal subjects had a small presystolic A wave (less than 125% of the end-diastolic IVC dimension), a small systolic V wave (less than 140% of the enddiastolic IVC dimension), and a 50% inspiratory decrease in IVC dimension. GRAY-SCALE B-SCAN ULTRASONOGRAPHY is useful for diagnosing masses invading or compressing the inferior vena cava (IVC).'-8 Furthermore, realtime two-dimensional echocardiographic detection of IVC microcavitations after peripheral contrast injection is valuable for diagnosing tricuspid insufficiency.9Ill The purpose of this report is to describe the normal and abnormal time-motion echocardiographic characteristics of IVC size and pulsation and to identify the physiologic and pathophysiologic determinants of the IVC echogram. Materials and MethodsThe time-motion IVC ultrasonographic data in 1 1 1 patients who also had hemodynamic, contrast right ventricular angiographic, radionuclide right ventricular angiographic or pathologic study form the basis of this report. Ten patients were normal. Sixty-seven patients had mitral stenosis, mitral insufficiency or mitral valve prosthesis. Nine patients had an atrial septal defect. One patient had a patent ductus arteriosus, one anomalous pulmonary venous drainage, one primary tricuspid insufficiency, five patients had coronary artery disease, 13 hypertrophic or congestive cardiomyopathy, three constrictive pericarditis, and one patient had recurrent pulmonary emboli with pulmonary hypertension. Eighteen of these patients required maintenance hemodialysis for chronic renal failure. IVC echographic studies were performed using a Varian V-3000 or V-3400 phased-array ultrasonoscope. The transducer was placed in a subxiphoid or right subcostal position and rotated so that the twodimensional sector was parallel to the IVC. In this manner, the course of the IVC behind the liver, extending through the diaphragm, and anastomosing with the right atrium12 was imaged ( fig. 1). The transducer was rocked slightly medially and laterally to record the maximum IVC size. The M-mode cursor of the two-dimensional sector was used to generate a time-motion recording of the IVC. The cursor was positioned inferior to the junction of the hepatic veins with the IVC. Care was taken not to measure the IVC where it dilates at the junction of the right atrium. A time-motion study of the IVC was recorded through several respiratory cycles. All measurements were normalized for body surface area and a mean of two respiratory cycles during normal quiet breathing was calculated. The end-diastolic IVC dimension was measured as the minimum IVC size at or after the R wave of the ECG; this was usually, but not always, the smallest IVC diameter during the entire cardiac cycle. A presystolic (A wave) pulsation was recorded in p...

The use of Tricuspid Annular Plane Systolic Excursion and Tissue Doppler Imaging Velocities for the Estimation of Pulmonary Hypertension and Right Ventricular Function in Mechanically Ventilated Patients

“…The method that seems more accurate was developed by Lichtenstein, and calculates IVC diameter longitudinally at end-expiration and end-diastole and during the R wave on electrocardiogram (ECG), 2 cm before the right atrium and with the M-mode on short axis view (Lichtenstein & Jardin, 1994). The estimation of RAP using IVC diameter and its respiratory collapse has been shown to correlate better with central venous pressure (CVP) in patients with RV dysfunction and PH (Mintz et al, 1981). It seems that since the normal respiratory augmentation in venous return is limited by RV enlargement, normal IVC diameter variations are reduced, increasing diagnostic accuracy of this technique.…”

Influence of breathing movements and Valsalva maneuver on vena caval dynamics

“…In the medical literature, there is no agreement on whether the IVC increases or decreases in diameter during the Valsalva maneuver [1][2][3][4][5][6][7] . In a study on the diameter of the IVC measured by ultrasound, Grant et al [1] acknowledged this controversy and observed a decrease of IVC caliber during the Valsalva maneuver with a maximum increase at the end of the forced inspiration.…”

Inferior Vena Cava Percentage Collapse During Respiration Is Affected by the Sampling Location: An Ultrasound Study in Healthy Volunteers

“…Studies have included healthy volunteers, 2 continuous ambulatory peritoneal dialysis patients, 3 hemodialysis patients, 4,5 healthy volunteers at phlebotomy centers, 6 and critically ill patients in intensive care units. 7,8 In addition, the locations of IVC measurements differ across studies [9][10][11][12][13][14][15][16][17][18][19] (Table 1). This study aimed to determine if the degree of IVC collapsibility (also referred to as ''caval index'') varied within the same subject at commonly measured sites.…”