The fetal venous system, Part I: normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation

Yagel, Simcha; Kivilevitch, Z.; Cohen, S. M.; Valsky, D. V.; Messing, B.; Shen, O.; Achiron, Reuven

doi:10.1002/uog.7618

Cited by 100 publications

(114 citation statements)

References 55 publications

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“…This view makes it possible to identify the left portal vein with all or some of its branches (superior, inferior, and medial), the confluence of the left portal vein with the right portal vein and its branches (anterior and posterior), and the anastomosis of both vessels with the main portal vein (Figure 2A). 19 The intrahepatic portion of the umbilical vein does not appear in this view, since the plane is slightly cranial to this vessel.…”

Section: View I: Portal Sinusmentioning

confidence: 94%

“…19,20 The ductus venosus is a thin vessel (about onethird the diameter of the umbilical vein) with its origin in the left portal vein, which courses right to merge with the right portal vein. The ductus venosus communicates the left portal vein with the inferior vena cava in cranial, lateromedial, and anteroposterior directions.…”

Section: View Ii: Ductus Venosusmentioning

confidence: 99%

“…At its left, it is possible to identify the stomach, the spine, and cross sections of the left descending aorta and inferior vena cava to the right ( Figure 2B). 19 …”

Section: View Ii: Ductus Venosusmentioning

confidence: 99%

“…According to Yagel et al, 19 sonographic visualization of the hepatic veins must be in a transverse plane of the fetal upper abdomen, with a slight oblique angle (<15°) anteriorly and above the ductus venosus. This efferent drainage system comprises 3 veins arranged in a trident: (1) the right hepatic vein; (2) the middle hepatic vein; and (3) the left hepatic vein.…”

Section: View Iii: Hepatic Veinsmentioning

confidence: 99%

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Cardiovascular System Sonographic Evaluation Algorithm

León-Luis

Bravo

Gámez

et al. 2015

J of Ultrasound Medicine

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Objectives To evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra‐aortic areas, in the second trimester of pregnancy (19–22 weeks). Methods We performed a cross‐sectional study of pregnant women with healthy fetuses (singleton and twin pregnancies) attending our center from March to August 2011. The extended fetal cardiovascular system was evaluated by following the new algorithm, a sequential acquisition of axial views comprising the following (caudal to cranial): I, portal sinus; II, ductus venosus; III, hepatic veins; IV, 4‐chamber view; V, left ventricular outflow tract; VI, right ventricular outflow tract; VII, 3‐vessel and trachea view; VIII, thy‐box; and IX, subclavian arteries. Interobserver agreement on the feasibility and exploration time was estimated in a subgroup of patients. The feasibility and exploration time were determined for the main cohort. Maternal, fetal, and sonographic factors affecting both features were evaluated. Results Interobserver agreement was excellent for all views except view VIII; the difference in the mean exploration time between observers was 1.5 minutes (95% confidence interval, 0.7–2.1 minutes; P < .05). In 184 fetuses (mean gestational age ± SD, 20 ± 0.6 weeks), the feasibility of all views was close to 99% except view VIII (88.7%). The complete feasibility of the algorithm was 81.5%. The mean exploration time was 5.6 ± 4.2 minutes. Only the occiput anterior fetal position was associated with a lower frequency of visualization and a longer exploration time (P < .05). Conclusions The cardiovascular system sonographic evaluation algorithm is a reproducible and feasible approach for exploration of the extended fetal cardiovascular system in a second‐trimester scan. It can be used to explore these areas in normal and abnormal conditions and provides an integrated image of extended fetal cardiovascular anatomy.

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Section: View I: Portal Sinusmentioning

confidence: 94%

Section: View Ii: Ductus Venosusmentioning

confidence: 99%

“…At its left, it is possible to identify the stomach, the spine, and cross sections of the left descending aorta and inferior vena cava to the right ( Figure 2B). 19 …”

Section: View Ii: Ductus Venosusmentioning

confidence: 99%

Section: View Iii: Hepatic Veinsmentioning

confidence: 99%

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Cardiovascular System Sonographic Evaluation Algorithm

León-Luis

Bravo

Gámez

et al. 2015

J of Ultrasound Medicine

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“…Turkiye Klinikleri J Gynecol Obst 2016;26 (1) 59 Dilate Umbilikal Ven ve İnferior Vena Kava İzlenen Fetüste Konjenital Duktus Venozus Agenezisi Ö ÖZ ZE ET T Duktus venozus (DV) agenezisi, nadir görülen bir vasküler anomalidir. Bu olgu çalışmadada, gastrointestinal ve iskelet sistemi anomalilerine eşlik eden DV agenezisini sunulmuştur.…”

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Congenital Ductus Venosus Agenesis in a Fetus with Dilated Umbilical Vein and Inferior Vena Cava: Case Report

Erzincan¹,

Sayın²,

İnan³

et al. 2016

Turkiye Klinikleri J Gynecol Obst

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Fetal dolaşım sistemi, mevcut olan üç şant nedenile erişkin dolaşım sisteminden farklılık göstermektedir. Bu şantlar duktus venozus (DV), foramen ovale, duktus arterirozus'tur. Fetal gelişim sürecinde başlan-gıçta bulunan sağ ve sol umbilikal venlerden sağdaki regrese olurken, sol umbilikal venin abdomene giriş yeri ile inferior vena kava arasındaki kısmı sebat ederek DV'yi oluşturmaktadır. Plasentadan umbilikal ven aracılığıyla dönen kanın yaklaşık %25 -30'luk kısmı DV yoluyla direktinferior vena kavaya dökülerek sağ atriyuma, buradan da foramen ovale yoluyla sol kalbe ve sistemik dolaşıma ulaşmaktadır. 59Dilate Umbilikal Ven ve İnferior Vena Kava İzlenen Fetüste Konjenital Duktus Venozus Agenezisi Ö ÖZ ZE ET T Duktus venozus (DV) agenezisi, nadir görülen bir vasküler anomalidir. Bu olgu çalışmadada, gastrointestinal ve iskelet sistemi anomalilerine eşlik eden DV agenezisini sunulmuştur. Polihidramniyor nedenile refere edilen olguda yapılan ultrasonografik değerlendirmede, polihidramniyoz yanı sıra özofagus atrezisi ve tek umbilikal arter saptandı. DV'in olmadığı ve umbilikal venin diret inferior vena kavaya drene olduğu izlendi. Preterm doğan yenidoğanda postnatal dönemde hemivertebra da saptandı ve karyotip sonucu normal olarak raporlandı. Postpartum dönemde kardiyovasküler komplikasyon gelişmeyen olgu bronkopulmoner displazi nedenile 71. gün kaybedildi. DV agenezisi, prenatal taramada dikkat edilmesi gereken önemli bir durumdur. Umbilikal venin ekstrahepatik yolla inferior vena kavaya drene olduğu tip DV agenezilerinde prognoz beklentisi özel-likle eşlik eden diğer anomalilere göre daha kötüdür.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Umblikal venler; prenatal tanı; anormallikler A AB BS S T TR RA AC CT T Agenesis of ductus venosus (DV) is a rare vascular abnormality. Here, we report a case of DV agenesis associated with gastrointestinal and skeletal system abnormalities. The patient was referred due to polyhydramnios, and on ultrasonographic evaluation besides polyhydramnios, esophageal atresia and single umbilical artery were also found. DV was not detected and it was observed that umbilical vein drained directly to the inferior vena cava. Hemivertebra and normal karyotype were also detected postnatally in the newborn who was delivered prematurely. Although the baby did not develop any cardiovascular complications the baby died because of bronchopulmonary dysplasia on postpartum 71 st day. Agenesis of DV is an important issue that should be paid attention in prenatal screening. The prognosis is worse in patients with agenesis of DV in which umbilical vein drains directly to inferior vena cava via extrahepatic way especially due to associated anomalies. K Ke ey y W Wo or rd ds s: : Umbilical veins; prenatal diagnosis; abnormalities T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J G Gy yn ne ec co ol l O

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Prenatal diagnosis of hepatic interruption of the inferior vena cava with azygos/hemiazygos continuation without structural heart defects: A case series

Babaoğlu

Doğan

Başar

et al. 2022

J of Clinical Ultrasound

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Objectives To describe fetal spectrum and echocardiographic characteristics of interrupted inferior vena cava (IIVC) with azygos/hemiazygous continuation without other structural heart defects and to evaluate its association with visceral heterotaxy and isomerism, extracardiac and genetic anomalies, and to review neonatal outcome. Methods This was a retrospective study of 14 fetuses with a confirmed diagnosis of IIVC with normal intracardiac anatomy. The following variables were collected; indication for referral, gestational age at diagnosis; associated isomerism and visceral heterotaxy, heart rhythm, genetic and extracardiac abnormalities, and fetal/neonatal outcome. Results Among 36 fetuses with IIVC, 14 cases (38.8%) had normal intracardiac anatomy. These IIVC cases correspond to 0.19% (14/7250) of all fetal cardiac examinations, and to 1.5% (14/922) of all cardiac abnormalities. Six patients had visceral abnormalities. Atrial appendage morphology was clearly depicted in three fetuses, both appendages were left. One fetus had bradyarrhythmia revealing atrial ectopic rhythm. Six fetuses did not have any concomitant cardiac or visceral abnormalities, therefore regarded as isolated. All babies were delivered at term with a good prognosis. Conclusion Our study has shown that almost half of the IIVC cases without intracardiac structural anomalies displayed other findings of isomerism while the other half was isolated benign vascular variant. Therefore, prenatal diagnosis of IIVC should prompt a comprehensive evaluation for cardiac, situs, and visceral anomalies. The outcome is favorable.

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The fetal venous system, Part I: normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation

Abstract: Since its introduction in the mid

Cited by 100 publications

References 55 publications

Cardiovascular System Sonographic Evaluation Algorithm

Cardiovascular System Sonographic Evaluation Algorithm

Congenital Ductus Venosus Agenesis in a Fetus with Dilated Umbilical Vein and Inferior Vena Cava: Case Report

Prenatal diagnosis of hepatic interruption of the inferior vena cava with azygos/hemiazygos continuation without structural heart defects: A case series

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