Ultrasound of the Fetal Veins Part 1: The Intrahepatic Venous System (2024)

Ultraschall Med 2014; 35(3): 208-228
DOI: 10.1055/s-0034-1366316

Continuing Medical Education

©Georg Thieme Verlag KG Stuttgart · New York

R. Chaoui

1   Center for Prenatal Diagnosis and Human Genetics, Friedrichstraße 147, Berlin, Germany

,

K. S. Heling

1   Center for Prenatal Diagnosis and Human Genetics, Friedrichstraße 147, Berlin, Germany

,

K. Karl

2   Prenatal Diagnosis Munich, Tegernseer Landstraße 64, 81541 Munich, Germany

› Author Affiliations

Further Information

Publication History

19 October 2013

21 February 2014

Publication Date:
28 May 2014 (online)

Permissions and Reprints

Ultrasound of the Fetal Veins Part 1: The Intrahepatic Venous System (2)

Learning objectives

  1. The examination of the intrahepatic fetal veins includes the evaluation of the umbilical vein, the portal venous system, the ductus venosus, the hepatic veins and the inferior vena cava.

  2. The complex anatomy of the afferent and efferent veins is explained using schemes, 2 D grayscale, color Doppler and 3 D color Doppler images.

  3. Typical abnormal findings are demonstrated and include the right umbilical vein, umbilical vein varix, different forms of agenesis of the ductus venosus and other rare intrahepatic vascular anomalies.

  4. The spectral Doppler examination of the veins focused mainly on the assessment of the ductus venosus flow in fetuses with increased right atrial preload, in screening for aneuploidies in early gestation, in cardiac anomalies as well as in fetuses with severe growth restriction.

  • References/Literatur

  • 1 Achiron R, Hegesh J, Yagel S et al. Abnormalities of the fetal central veins and umbilico-portal system: prenatal ultrasonographic diagnosis andproposed classification. Ultrasound Obstet Gynecol 2000; 16: 539-548
  • 2 Yagel S, Kivilevitch Z, Cohen SM et al. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. Ultrasound Obstet Gynecol 2010; 36: 93-111
  • 3 Yagel S, Kivilevitch Z, Cohen SM et al. The fetal venous system, part I: normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation. Ultrasound Obstet Gynecol 2010; 35: 741-750
  • 4 Shen O, Valsky DV, Messing B et al. Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis. Ultrasound Obstet Gynecol 2011; 37: 184-190
  • 5 Kiserud T, Eik-Nes SH, Blaas HG et al. Ultrasonographic velocimetry of the fetal ductus venosus. Lancet 1991; 338: 1412-1414
  • 6 Kiserud T, Eik-Nes SH, Blaas HG et al. Foramen ovale: an ultrasonographic study of its relation to the inferior vena cava, ductus venosus and hepatic veins. Ultrasound Obstet Gynecol 1992; 2: 389-396
  • 7 Haugen G, Kiserud T, Godfrey K et al. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol 2004; 24: 599-605
  • 8 Kiserud T. Physiology of the fetal circulation. Semin Fetal Neonatal Med 2005; 10: 493-503
  • 9 Kessler J, Rasmussen S, Kiserud T. The fetal portal vein: normal blood flow development during the second half of human pregnancy. Ultrasound Obstet Gynecol 2007; 30: 52-60
  • 10 Mavrides E, Moscoso G, Carvalho JS et al. The anatomy of the umbilical, portal and hepatic venous systems in the human fetus at 14–19 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18: 598-604
  • 11 Kalache K, Romero R, Goncalves LF et al. Three-dimensional color power imaging of the fetal hepatic circulation. Am J Obstet Gynecol 2003; 189: 1401-1406
  • 12 Sinkovskaya E, Klassen A, Abuhamad A. A novel systematic approach tothe evaluation of the fetal venous system. Semin Fetal Neonatal Med 2013; 18: 269-278
  • 13 Fasouliotis SJ, Achiron R, Kivilevitch Z et al. The human fetal venous system: normal embryologic, anatomic, and physiologic characteristics and developmental abnormalities. J Ultrasound Med 2002; 21: 1145-1158
  • 14 Achiron R, Gindes L, Kivilevitch Z et al. Prenatal diagnosis of congenital agenesis of the fetal portal venous system. Ultrasound Obstet Gynecol 2009; 34: 643-652
  • 15 Kivilevitch Z, Gindes L, Deutsch H et al. In-utero evaluation of the fetal umbilical-portal venous system: two- and three-dimensional ultrasonic study. Ultrasound Obstet Gynecol 2009; 34: 634-642
  • 16 Kiserud T, Rasmussen S, Skulstad S. Blood flow and the degree of shunting through the ductus venosus in the human fetus. Am J Obstet Gynecol 2000; 182: 147-153
  • 17 Weichert J, Hartge D, Germer U et al. Persistent right umbilical vein: a prenatal condition worth mentioning?. Ultrasound Obstet Gynecol 2011; 37: 543-548
  • 18 Mankuta D, Nadjari M, Pomp G. Isolated fetal intra-abdominal umbilical vein varix: clinical importance and recommendations. J Ultrasound Med 2011; 30: 273-276
  • 19 Weissmann-Brenner A, Simchen MJ, Moran O et al. Isolated fetal umbilical vein varix – prenatal sonographic diagnosis and suggested management. Prenat Diagn 2009; 29: 229-233
  • 20 Czubalski A, Aleksandrowicz R. Connection types between portal vein and portal sinus during foetal life. Folia Morphol (Warsz) 2000; 59: 97-98
  • 21 Berg C, Kamil D, Geipel A et al. Absence of ductus venosus-importance of umbilical venous drainage site. Ultrasound Obstet Gynecol 2006; 28: 275-281
  • 22 Achiron R, Gindes L, Gilboa Y et al. Umbilical vein anomaly in fetuses with Down syndrome. Ultrasound Obstet Gynecol 2010; 35: 297-301
  • 23 Sau A, Sharland G, Simpson J. Agenesis of the ductus venosus associated with direct umbilical venous return into the heart – case series and review of literature. Prenat Diagn 2004; 24: 418-423
  • 24 Staboulidou I, Pereira S, de-Jesus-Cruz J et al. Prevalence and outcome of absence of ductus venosus at 11(+0) to 13(+6) weeks. Fetal Diagn Ther 2011; 30: 35-40
  • 25 Guerin F, Blanc T, Gauthier F et al. Congenital portosystemic vascular malformations. Semin Pediatr Surg 2012; 21: 233-244
  • 26 Lautz TB, Tantemsapya N, Rowell E et al. Management and classification of type II congenital portosystemic shunts. J Pediatr Surg 2011; 46: 308-314
  • 27 Tseng JJ, Chou MM, Lee YH et al. Prenatal diagnosis of intrahepatic arteriovenous shunts. Ultrasound Obstet Gynecol 2000; 15: 441-444
  • 28 Hartung J, Chaoui R, Kalache K et al. Prenatal diagnosis of intrahepatic communications of the umbilical vein with atypical arteries (A-V fistulae) in two cases of trisomy 21 using color Doppler ultrasound. Ultrasound Obstet Gynecol 2000; 16: 271-274
  • 29 Gill RW, Trudinger BJ, Garrett WJ et al. Fetal umbilical venous flow measured in utero by pulsed Doppler and B-mode ultrasound. I. Normal pregnancies. Am J Obstet Gynecol 1981; 139: 720-725
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  • Supplementary Material
Ultrasound of the Fetal Veins Part 1: The Intrahepatic Venous System (2024)

FAQs

What is the venous system of the fetus? ›

The main function of the fetal venous system is to deliver blood rich with oxygen and nutrients from the placenta to the fetal heart. The DV plays a critical role in this important function.

What does it mean when the ductus venosus flow is normal? ›

Most studies examining ductus venosus flow have classified the waveforms as normal, when the a-wave observed during atrial contraction is positive, or abnormal, when the a-wave is absent or reversed.

What is absent ductus venosus with intrahepatic shunt? ›

In the absence of ductus venosus the umbilical vein may drain normally into the liver (intrahepatic shunt) or may drain in an aberrant location into the systemic circulation (e.g., iliac vein, inferior vena cava, right heart and coronary sinus) creating an extrahepatic shunt.

What is the prognosis for agenesis of DV? ›

Agenesis of DV is a rare vascular anomaly, and the use of Doppler ultrasound has enabled us to diagnose the same as early as 11–13+6 weeks. Our study reveals that fetuses with isolated DVA have a near-normal prognosis.

What is the purpose of the venous system? ›

Veins return blood to the heart from all the organs of the body. Arteries carry blood with oxygen and nutrients away from the heart to the rest of the body.

What is the venous system responsible for? ›

The arterial blood supply is responsible for perfusing the body with oxygenated and nutrient-rich blood, while the venous blood drainage is responsible for draining the deoxygenated blood and metabolic waste.

What does an abnormal ductus venosus mean? ›

Abnormal DV flow (absent or reversed A-wave during atrial contraction) is a sign of cardiac dysfunction in the second and third trimesters. From: Fetal Medicine (Third Edition), 2020.

What is abnormal ductus venosus flow in the first trimester? ›

Abnormal ductus venosus flow increases the risk of cardiac defects in fetuses with NT above the 95th centile, and it may increase the risk in fetuses with normal NT. In twin pregnancies, abnormal ductus venosus flow is associated with chromosomal abnormalities and cardiac defects.

What happens if ductus venosus is absent? ›

Fetuses with absence of the ductus venosus are at risk of other congenital anomalies including facial clefts, hemivertebrae, cardiac, genitourinary, gastrointestinal anomalies; affected infants also have a poorer prognosis.

What are the complications of ductus venosus? ›

Failure of the ductus venosus to close may result in galactosemia, hypoxemia, encephalopathy with hyperammonia, and hepatic dysfunction. We report an infant with complex congenital heart disease (CHD) who developed coagulopathy and hyperammonia during the preoperative period secondary to patent ductus venosus (PDV).

How common is absent ductus venosus? ›

Ductus venosus agenesis is a rare anomaly which is significantly associated with cardiac, extracardiac and chromosomal anomalies.

What is the primary importance of the ductus venosus in the fetus? ›

The primary function of the ductus venosus is to carry oxygenated blood from the umbilical vein to the inferior vena cava and, ultimately, the left heart for systemic circulation while the portal sinus supplies oxygenated blood to the liver itself.

How many babies are born with agenesis of the corpus callosum? ›

Agenesis (absence) of the corpus callosum is a condition in which this structure is either partially or completely missing. It is the most common congenital brain abnormality and may be present in 1 per 4,000 live births.

Is there a treatment for agenesis? ›

vagin*l agenesis is often identified at puberty when a female does not begin menstruating. Use of a vagin*l dilator, a tubelike device that can stretch the vagin* when used over a period of time, is often successful in creating a vagin*. In some cases, surgery may be needed.

What is meant by venous system? ›

The venous system refers to the network of veins that work to deliver deoxygenated blood back to your heart.

What changes in venous system in pregnancy? ›

During normal pregnancy important changes in central venous blood flow occur. At the level of the kidneys, venous flow velocities increase during the first trimester of pregnancy and reach a plateau level in the second trimester, followed by a decrease in the third trimester21.

What is the venous supply of the uterus? ›

The blood supply to the uterus is via the uterine artery. Venous drainage is via a plexus in the broad ligament that drains into the uterine veins. Lymphatic drainage of the uterus is via the iliac, sacral, aortic and inguinal lymph nodes.

What are the parts of the venous system? ›

The three main compartments of the venous system are the deep veins, the superficial veins, and the perforator veins.

References

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