Update on Echocardiography of the Inferior Vena Cava

Inferior Vena Cava Diameter (IVCD) Measured with Transesophageal Echocardiography (TEE) Can Be Used to Derive the Central Venous Pressure (CVP) in Anesthetized Mechanically Ventilated Patients

“…It is well established that IVC dilatation and loss of normal inspiratory decrease in diameter are reliable and sensitive markers of elevated CVP 7,8 . However, loss of the normal inspiratory decrease in IVCD has not been found to be reliable in anesthetized, mechanically ventilated patients.…”

“…The IVC, a highly compliant vessel, carries about 80% of the venous that returns to the right heart and varies in its size and dynamics with changes in the intravascular volume of the patient. The uppermost 1 inch of the IVC just below its entry into the right atrium is within the thorax with the anterior aspect covered by pericardium which may be subject to intrapericardial pressure 7,8 . Because pressure varies with the site of measurement in part due to hydrostatic forces, vessel caliber, and its distance from the heart, we hypothesized that by measuring the inferior vena cava diameter (IVCD) in this cohort of 95 anesthetized, mechanically ventilated patients at the cavo‐atrial junction to coincide with the end of the T‐wave, a true reflection of the right atrial pressure (RAP) could be obtained which would allow CVP values to be calculated.…”

Association of Coronary Sinus Diameter with Pulmonary Hypertension

“…Decreased respiratory effort, by causing smaller swings of intrapleural pressure, can simulate VCI plethora. Conversely, increased respiratory effort, as may occur due to various cardiac or respiratory causes, might prevent VCI plethora from being manifest even when the central venous pressure is high 15 . Brennan et al 6 evaluated echocardiographic imaging of the VCI for estimation of RAP in 102 patients undergoing right heart catheterization and found that traditional classification of RAP into 5 mmHg ranges based on VCI size and collapsibility performed poorly (43% accurate).…”

Three‐Dimensional Echocardiographic Appearances of Pericardial Effusion with Tamponade

“…In this brief report, we describe the three‐dimensional echocardiographic appearances in a patient with definite clinical tamponade, including right atrial, right ventricular, and left atrial “collapse.” Certain recently mentioned contour changes of the intrathoracic inferior vena cava in tamponade 5 were also well seen on three‐dimensional echo.…”

“…Deformation of the anterior aspect of the intrathoracic segment of the inferior vena cava, as a sign of tamponade went unnoticed until very recently 5 . This occurs because this small terminal segment of the inferior vena cava is partly intrapericardial, pericardium investing it anteriorly but not posteriorly.…”