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Piemonti L, Simonetto C, Bovino A, Pinto A, Garzon S, Grisolia G, Raffaelli R. Agenesis of the ductus venosus and fetal growth restriction: Is there a relation? A tertiary care center experience and systematic review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38767265 DOI: 10.1002/jcu.23718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
An update on the antenatal diagnosis of agenesis of ductus venosus (ADV) by differentiating the various possible types of shunts, focusing on the associated fetal anomalies, and predicting neonatal outcomes. This study reviewed the experience of two tertiary referral centers and literature. An unfavorable outcome was detected in preterm fetuses (p = 0.017), fetuses with a genetic anomaly (p = 0.046) or other associated malformations (p < 0.001). 71% of ADVs with other anomalies had an extrahepatic ADV (p = 0.002). 76% of fetuses with Fetal Growth Restriction (FGR) had an extrahepatic ADV (p = 0.025). ADV may negatively influence fetal growth in cases with extrahepatic vein drainage.
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Affiliation(s)
- Linda Piemonti
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Chiara Simonetto
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Alessandra Bovino
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
| | - Alessia Pinto
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Chan ES, Suchet I, Yu W, Somerset D, Soliman N, Kuret V, Chadha R. Absence of Ductus Venosus: A Comparison of 2 Distinctive Fetal Autopsy Cases and Embryologic Perspectives. Pediatr Dev Pathol 2024; 27:139-147. [PMID: 38098271 PMCID: PMC11015709 DOI: 10.1177/10935266231211760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In fetal circulation, oxygenated blood from the placenta flows through the umbilical vein into the ductus venosus (DV), then enters the inferior vena cava, and subsequently reaches the right atrium of the heart. The DV serves as a shunt, allowing this oxygen-rich blood to bypass the liver. The absence of the DV (ADV), also known as agenesis of the DV, is a rare congenital anomaly. Without a DV, blood from the umbilical vein must follow alternative routes to the heart. In ADV cases, blood from the umbilical vein must follow 1 of 2 primary drainage patterns: either an extrahepatic shunt or an intrahepatic shunt. This report details the antenatal ultrasound and postmortem findings of 2 fetuses diagnosed with ADV by prenatal imaging studies. The first case involved a fetus with a persistent right umbilical vein connected directly to the suprahepatic IVC, accompanied by early obliteration of the left umbilical vein and true agenesis of the DV. This fetus also had additional congenital anomalies. In contrast, the second case involved a fetus with a normal left umbilical vein that entered the liver. However, despite an ultrasound diagnosis of "absence" of the DV, a DV was present, though markedly hypoplastic and probably minimally functional or non-functional. In this case, blood from the umbilical vein likely followed an alternate intrahepatic route through the portal and hepatic veins, before reaching the heart (intrahepatic shunt). These contrasting cases emphasize the heterogeneity of vascular anomalies and embryologic origins captured by the term "ADV." Additionally, the terminology of "absence" or "agenesis" may be misleading in some purported ADV cases. Specifically, in the second case, the DV was not absent; it was markedly hypoplastic instead. This also appears to be the first reported case of a hypoplastic DV in a fetus. Both cases underscore the importance of effective collaboration and clear communication between maternal-fetal medicine specialists and pathologists.
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Affiliation(s)
- Elaine S. Chan
- Department of Pathology and Laboratory Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Alberta Precision Laboratories, Calgary, AB, Canada
- Alberta Children’s Hospital, Calgary, AB, Canada
| | - Ian Suchet
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Weiming Yu
- Department of Pathology and Laboratory Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Alberta Precision Laboratories, Calgary, AB, Canada
- Alberta Children’s Hospital, Calgary, AB, Canada
| | - David Somerset
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
| | - Nancy Soliman
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
| | - Verena Kuret
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
| | - Rati Chadha
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
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Elbistanli C, Yozgat Y, Dogan MS, Yozgat CY, Kütük MS. Prenatal Detection and Postnatal Outcome of Persistent Left Superior Vena Cava and Agenesis of Ductus Venosus Associated with Postnatal Bovine Aortic Arch. Z Geburtshilfe Neonatol 2023. [PMID: 38122805 DOI: 10.1055/a-2219-9889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Isolated agenesis of ductus venosus (ADV) is usually a benign condition, but it may be associated with cardiovascular defects, hydrops, growth restriction, and chromosomal abnormalities. Additionally, persistent left superior vena cava (PLSVC) and bovine aortic arch are relatively common fetal anomalies. To the author's knowledge, this is the first report of prenatal detection of DV agenesis and PLSVC associated with the postnatal bovine aortic arch with a hypoplastic transverse aortic arch. CASE A 25-year-old, G2P1 woman was referred to our department at 31 weeks due to fetal growth restriction and short femur. On fetal echocardiography, DV could not be viewed via two-dimensional (2D) and Doppler ultrasound (US) imaging; there was also evidence of the co-occurrence of PLSVC and an aortic arch anomaly. We revealed the intrahepatic continuation of the umbilical vein. A weekly follow-up program was scheduled for the patient and the rest of the pregnancy was uneventful. Postnatal, thorax computer tomography and transthoracic echocardiography (TTE) demonstrated PLSVC and bovine aortic arch associated with hypoplastic transverse aortic arch. Routine echocardiographic examinations revealed that the blood flow of the aortic arch had increased gradually, and the male infant's aortic arch had significantly widened and reached the normal range until the baby was discharged from the hospital. CONCLUSION DV agenesis and PLSVC are usually benign conditions but underlying serious heart diseases may accompany them. Therefore, in situations like ours, a prenatal aortic arch evaluation is of capital importance. Postnatal hemodynamic changes should be taken into consideration in the management of these cases. This is the first example in the literature that these abnormalities co-existed in one case.
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Affiliation(s)
| | - Yılmaz Yozgat
- Pediatric Cardiology, Istanbul Medipol Universitesi, Istanbul, Turkey
| | - Mehmet Said Dogan
- Pediatric Radiology, Istanbul Medipol Universitesi, Istanbul, Turkey
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Lu L, Yao L, Wei H, Hu J, Li D, Yin Y, Su J, Li Q, Zhu S, Tang X, Huang W, Zhu B, Zhang J. Ultrasonographic classification of 26 cases of fetal umbilical-portal-systemic venous shunts and the correlations with fetal chromosomal abnormalities. BMC Pregnancy Childbirth 2023; 23:236. [PMID: 37038108 PMCID: PMC10084610 DOI: 10.1186/s12884-023-05525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/16/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE To investigate the ultrasonographic classification of fetal umbilical-portal-systemic venous shunts (UPSVS) and the correlations with fetal chromosomal abnormalities. METHODS We retrospectively analyzed the ultrasound characteristics and the corresponding chromosomal abnormalities of 26 cases of fetal UPSVS prenatally diagnosed. RESULTS A total of 26 fetuses diagnosed as UPSVS were included, including four cases of type I UPSVS, ten of type II, three of type IIIA, and nine of type IIIB. Four cases of type I were all complicated by fetal heart enlargement and heart insufficiency, of which one case had multiple malformations, and all four cases terminated pregnancies. Six of ten cases of type II terminated pregnancies, including four of Down's syndrome, one of twin reversed arterial perfusion sequence, one of fetal edema but with normal copy number variation (CNV) by chorionic villus sampling. The other four of ten cases were isolated type II with normal chromosomes, which were delivered at full term and were normal in growth and development when followed up 34 months after birth. Three cases of type IIIA all terminated pregnancies, of which one had multiple malformations, one had right multicystic dysplastic kidney, and one had fetal heart enlargement and heart failure. Among nine of type IIIB, seven with chromosomal abnormalities and/ or complicated malformations terminated pregnancies, and two with isolated type IIIB and normal chromosomes were delivered at full term, and were normal in growth and development (one was followed up to 33 months after birth and the other 20 months after birth). CONCLUSION Fetal UPSVS can be clearly diagnosed and typed by prenatal ultrasonography. Fetal prognosis is determined by the types of UPSVS and complicated malformations and/ or chromosomal abnormalities. The probability of fetal chromosomal abnormalities in UPSVS fetuses is related to the ultrasonographic classification.
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Grants
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
- 2019ZF015 Major Scientific and Technological Project of Yunnan Province, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases
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Affiliation(s)
- Lihua Lu
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, 650500, P.R. China
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
- Department of Medical Ultrasonics, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, 530021, P.R. China
| | - Limin Yao
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Hui Wei
- Department of Medical Ultrasonics, Prenatal Diagnosis Center of Guangxi Zhuang Autonomous Region, Maternity and Child Health-care Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530028, P.R. China
| | - Jilin Hu
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Dongmei Li
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Yifei Yin
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Jie Su
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Qian Li
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Shu Zhu
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Xinhua Tang
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Wenming Huang
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Baosheng Zhu
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, 650500, P.R. China
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China
| | - Jinman Zhang
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, 650500, P.R. China.
- National Health Commission Key Laboratory of Preconception Health Birth in Western China, Yunnan Provincial Clinical Research Center for Birth Defects and Rare Diseases, Department of Obstetrics and Gynecology, Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, 650032, P.R. China.
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Muacevic A, Adler JR, Tasias K, Fasoulakis Z, Daskalakis G. The Incidence of the Agenesis of Fetal Ductus Venosus at the 11-13 Weeks' Ultrasound Examination. Cureus 2022; 14:e31748. [PMID: 36569677 PMCID: PMC9770524 DOI: 10.7759/cureus.31748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective is to examine the incidence of agenesis of fetal ductus venosus (DV) at the routine ultrasound examination at 11-13 weeks. MATERIALS AND METHODS This is a retrospective study on women presenting for screening for chromosomal abnormalities. The fetal DV was routinely examined by color Doppler in the sagittal view. RESULTS Out of 8,304 fetuses examined, there were 13 cases of DV agenesis (0.15%). The umbilical vein drainage was intra-hepatic in two-thirds of the cases, and all resulted in normal live births. In the remaining one-third of cases, the umbilical vein drained to the inferior vena cava and all had a poor outcome because of aneuploidies, cardiac defects, and Noonan syndrome. CONCLUSION Fetal DV agenesis occurs in about one in 650 fetuses and the majority of cases have a benign course and a favorable outcome. Failure to identify the DV should prompt a detailed ultrasound examination, identification of the drainage site of the umbilical vein, and genetic testing.
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Nagy RD, Cernea N, Dijmarescu AL, Manolea MM, Zorilă GL, Drăgușin RC, Vrabie SC, Dîră LM, Sîrbu OC, Novac MB, Drăgoescu NAM, Gheonea M, Stoica GA, Căpitănescu RG, Iliescu DG. Ductus Venosus Agenesis and Portal System Anomalies-Association and Outcome. BIOLOGY 2022; 11:548. [PMID: 35453747 PMCID: PMC9031854 DOI: 10.3390/biology11040548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
To evaluate the prenatal diagnosis of agenesis of ductus venosus (ADV) and portal venous system (PVS) anomalies and describe the outcome of these cases, either isolated or associated. We evaluated the intrahepatic vascular system regarding the presence of normal umbilical drainage and PVS characteristics in the second and third trimester of pregnancy. The associated anomalies and umbilical venous drainage were noted. Follow-up was performed at six months follow-up. Ultrasonography was performed in 3517 cases. A total of 19 cases were prenatally diagnosed: 18 ADV cases, seven abnormal PVS cases, and six associations of the two anomalies. We noted an incidence of 5.1‱ and 1.9‱ for ADV and PVS anomalies, respectively. Out of the 18 ADV cases, 27.7% were isolated. Five cases (26.3%) presented genetic anomalies. PVS anomalies were found in 33.3% of the ADV cases. ADV was present in 85.7% of the PVS anomalies. DV and PVS abnormalities were found with a higher than reported frequency. Normal DV is involved in the normal development of the PVS. Additional fetal anomalies are the best predictor for the outcome of ADV cases. Evaluation of PVS represents a powerful predictor for ADV cases and addresses the long-term prognosis.
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Affiliation(s)
- Rodica Daniela Nagy
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.D.N.); (L.M.D.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Nicolae Cernea
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
| | - Anda Lorena Dijmarescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Maria-Magdalena Manolea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Roxana Cristina Drăgușin
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Sidonia Cătălina Vrabie
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Laurențiu Mihai Dîră
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.D.N.); (L.M.D.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Ovidiu Costinel Sîrbu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Marius Bogdan Novac
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (N.A.M.D.)
- Department of Anesthesia and Intensive Care, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Nicoleta Alice Marinela Drăgoescu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (N.A.M.D.)
- Department of Anesthesia and Intensive Care, University Emergency County Hospital, 200642 Craiova, Romania
| | - Mihaela Gheonea
- Department of Neonatology, University Emergency County Hospital, 200642 Craiova, Romania;
- Department of Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - George Alin Stoica
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
- Department of Pediatric Orthopedic Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Pediatric Orthopedic Surgery, University Emergency County Hospital, 200642 Craiova, Romania
| | - Răzvan Grigoraș Căpitănescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Dominic-Gabriel Iliescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
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Prenatal Diagnosis and Outcome of Umbilical–Portal–Systemic Venous Shunts: Experience of a Tertiary Center and Proposal for a New Complex Type. Diagnostics (Basel) 2022; 12:diagnostics12040873. [PMID: 35453921 PMCID: PMC9027129 DOI: 10.3390/diagnostics12040873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Aims: To share our experience in the prenatal diagnosis of umbilical–portal–systemic venous shunts (UPSVS) and to study the prognostic factors for proper prenatal and perinatal management. Material and Methods: A five-year prospective study regarding the detection of UPSVS was conducted in two referral centers, Medgin Ginecho Clinic and the Prenatal Diagnostic Unit of the tertiary center, University Emergency County Hospital Craiova, Romania. We included in the analysis a series of agenesis of ductus venosus (ADV) cases previously reported by our center. We analyzed the incidence of the UPSVS types, their associations, and outcome predictors. Results: UPSVS were diagnosed in all 16 cases that were presented to our center at the time of first trimester anomaly scan, except one (94.12%). We diagnosed: 19 type I (61.2%), 4 type II (12.9%) and 5 type IIIa (16.1%) UPSVS. In three cases (9.6%) we noted multiple shunts, which we referred to as type IV (a new UPSVS type). Type IIIa-associated fetal growth restriction (FGR) was found in 60% of cases. Major anomalies worsened the outcome. Of the UPVSS cases, 57.1% were associated with PVS anomalies. Genetic anomalies were present in 40% of the tested cases. Conclusions: The incidence of UPSVS in our study was 0.2%. Early detection is feasible. The postnatal outcome mainly depends on the presence of structural, genetic and PVS anomalies. FGR may be associated. The new category presented a poor outcome secondary to poor hemodynamic and major associated anomalies.
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Feasibility of Fetal Portal Venous System Ultrasound Assessment at the FT Anomaly Scan. Diagnostics (Basel) 2022; 12:diagnostics12020361. [PMID: 35204452 PMCID: PMC8871164 DOI: 10.3390/diagnostics12020361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: To investigate the feasibility of the first trimester (FT) ultrasound scan (US) for the evaluation of the fetal portal venous system (PVS) anatomy, and to evaluate the potential of microcopy for a proper pathology evaluation for the PVS in the FT. Methods: We evaluated the PVS in 200 scan examinations performed in FT pregnancy. Half of the cases were scanned by two operators with extensive experience in obstetric ultrasound—Group I, and the other half was evaluated by two sonographers with less experience—Group II. Second-trimester US and autopsy in terminated pregnancies were used as follow-up. The pathologic evaluation was supported by microscopy. Results: all PVS features were successfully assessed by transabdominal ultrasound (TAUS) in 27% of the Group I cases and 14% in Group II. These rates increased to 88% in Group I and in 72% in Group II, after rescanning and using transvaginal ultrasound (TVUS). The conditions that led to rescanning and TVUS were: BMI greater than 24 in 26% cases, unfavorable fetal position (12.32%), retroverted uterus (12.32%), abdominal scar (10.96%), fibroids (4.11%), and combinations of the above (34.23%). The L-shaped UV confluence was identified transabdominally in 91% in Group I and in 79% in Group II and increased to 98% and 95%, respectively, following reevaluations. Microscopy represented a useful audit in all FT investigated cases. Conclusions: At the end of the FT, the visualization of a normal L-shaped UV confluence, that excludes major PVS abnormalities, is achievable in approx. 80%, indifferently the examiners experience. The sonographers experience, pregnant women BMI, and uterine anomalies as fibroids or retroversion significantly affect the rate of visualization, and necessitates vaginal approach and reexamination. The FT pathology, the audit of the ultrasound findings can only be performed microscopically, with relatively little resources involved and good results.
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Dong X, Wu H, Zhu L, Cong X, Li Q, Tang F, Tao G. Prenatal Ultrasound Analysis of Umbilical-Portal-Systemic Venous Shunts Concurrent With Trisomy 21. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1307-1312. [PMID: 32951221 DOI: 10.1002/jum.15507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A classification termed umbilical-portal-systemic venous shunt (UPSVS) for an abnormal umbilical vein (UV), portal vein (PV), and ductus venosus (DV) was proposed recently. According to this classification, there are 3 types of UPSVSs: types I, II, and III. Trisomy 21 associated with UV-PV-DV anomalies has been described, but the incidence of trisomy 21 in UPSVS cases, the relationship between UPSVS types and trisomy 21, and the pregnancy outcome are poorly documented. This study aimed to address these issues. METHODS All UPSVS cases diagnosed at our department from 2016 to 2019 were retrospectively studied. The English literature describing UV-PV-DV anomalies and trisomy 21 from 2000 to 2019 was searched, and the retrieved cases were analyzed. RESULTS Four of 20 UPSVS cases identified by us also had trisomy 21, with 2 type I and 2 type II UPSVSs. Ultrasound markers of Down syndrome were observed in all 4 cases that underwent termination of pregnancy (TOP). The literature search retrieved 12 reports including 279 patients, with 29 also having trisomy 21, giving a pooled trisomy 21 incidence rate of 10.4%. Of the 29 cases, 16 had type I, and 9 had type II, whereas UPSVS types in 4 were undeterminable, and 22 cases underwent TOP. CONCLUSIONS There is a high incidence of trisomy 21 in UPSVS cases. Trisomy 21 is associated with a type I or II UPSVS. Most cases with the combined defect underwent TOP. These findings may be used to direct prenatal counseling and management of the combined condition.
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Affiliation(s)
- Xiangyi Dong
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haifang Wu
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Linlin Zhu
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiang Cong
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qi Li
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengye Tang
- Zibo Lianchi Women and Infants Hospital, Zibo, China
| | - Guowei Tao
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Prenatal diagnosis of an aberrant ductus venosus draining into the coronary sinus using two- and three-dimensional echocardiography: a case report. BMC Pregnancy Childbirth 2021; 21:392. [PMID: 34016078 PMCID: PMC8136173 DOI: 10.1186/s12884-021-03870-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background Ductus venosus (DV) abnormalities may be associated with intracardiac or extracardiac deformities, chromosomal anomalies, and/or congestive heart failure. Aberrant DV connecting with the coronary sinus (CS) is rare and the prenatal diagnosis presents challenges for most examiners. Case presentation A 35-year-old pregnant woman, gravida 2, para 1, was referred to our center at 27 gestational weeks for a full evaluation of fetal cardiac anomalies. Transverse scans indicated normal cardiac anatomy except for a dilated CS; we then scanned sagittal planes to clarify the reasons for the CS dilatation. High-definition flow imaging (HDFI) together with radiant flow (R-flow) imaging was used to delineate the aberrant DV returning to the CS, enabling the diagnosis. Three-dimensional (3D) technology was also used to obtain color-rendered images showing the spatial relationships of the vessels involved, thus confirming the two-dimensional (2D) diagnosis. Chromosomal analysis revealed a normal karyotype. The neonate appeared healthy and the echocardiogram showed a normal cardiac anatomy except for a dilated CS with the DV closed and imperceptible. Conclusions The aberrant course of the DV returning to the CS was clearly demonstrable by traditional 2D echocardiography using HDFI and the R-flow technique. We deem it helpful to trace the inflow of the dilated CS to make the differential diagnosis. The 3D modality might also provide additional spatial information on the associated vessels and thereby assist in prenatal diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03870-x.
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Karmegaraj B. Normal Fetal Umbilical, Portal, and Hepatic Venous System: Four-dimensional STIC Rendering. Radiology 2021; 299:51. [PMID: 33497319 DOI: 10.1148/radiol.2021203300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Online supplemental material is available for this article.
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Affiliation(s)
- Balaganesh Karmegaraj
- From the Sowmi Fetal and Pediatric Echo Laboratory, Tirunelveli, India; and Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi 682041, India
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McBrien A, Caluseriu O, Niederhoffer KY, Hornberger LK. Prenatal features, associated co-morbidities and clinical course of agenesis of the ductus venosus in the current era. Prenat Diagn 2020; 41:15-20. [PMID: 32920862 DOI: 10.1002/pd.5827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Agenesis of the ductus venosus (ADV) has been associated with additional anomalies in up to 83% of cases. We sought to investigate characteristics, co-morbidities and outcomes of ADV in the current era. We hypothesized that rates of cardiac and non-cardiac diagnoses and survival would be higher, due to advances in genetic testing, prenatal diagnosis and surveillance. METHODS A retrospective series of cases diagnosed at our institution from 2007 to 2018 were identified by searching our database. Cardiac and obstetric charts were reviewed for cardiac and extra-cardiac anomalies, genetic results and outcomes. RESULTS Fourteen cases were diagnosed at a mean gestational age of 23.9 weeks (range 13-33). All had associated genetic, cardiac or extra-cardiac anomalies. Eight (57%) had cardiac anomalies and one other developed cardiomyopathy by 6 months. Extra-cardiac anomalies were present in 93% (13/14) and genetic diagnoses made in 75% (6/8) of those tested. Cardiac output Z-scores were >2 in 60% (6/10) prior to delivery. Two had hydrops, there was one intra-uterine death, 13 live-births and two neonatal deaths. CONCLUSION Our cohort had more associated diagnoses and a lower mortality than previously reported. In our experience, high output occurs frequently, however with a relatively low risk of hydrops and intrauterine death.
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Affiliation(s)
- Angela McBrien
- Fetal and Neonatal Cardiology Program, Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Oana Caluseriu
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Y Niederhoffer
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa K Hornberger
- Fetal and Neonatal Cardiology Program, Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Women's and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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Tang H, Song P, Wang Z, Han B, Meng X, Pan Y, Meng X, Duan W. A basic understanding of congenital extrahepatic portosystemic shunt: incidence, mechanism, complications, diagnosis, and treatment. Intractable Rare Dis Res 2020; 9:64-70. [PMID: 32494552 PMCID: PMC7263991 DOI: 10.5582/irdr.2020.03005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Extrahepatic portosystemic shunt belongs to a family of rare vascular abnormalities. The clinical importance and manifestations of this vascular abnormality range from asymptomatic cases to liver or metabolic dysfunctions of various degrees. Congenital extrahepatic portosystemic shunt, also termed as Abernethy malformation, is a very rare congenital vascular malformation in which splenomesenteric blood drains into a systemic vein, bypassing the liver through a complete or partial extrahepatic shunt. So far, limited cases of congenital extrahepatic portosystemic shunt have been reported. In this review, incidence, mechanisms, complications, diagnoses and treatments of congenital extrahepatic portosystemic shunt are described.
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Affiliation(s)
- Haowen Tang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Peipei Song
- The Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Zhiqiang Wang
- Department of Hepatobiliary Surgery, Qinghai Red Cross Hospital, Xining, China
| | - Bing Han
- Department of General Surgery, Shanxian Central Hospital, Heze, China
| | - Xiangfei Meng
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Yingwei Pan
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Xuan Meng
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- Address correspondence to:Weidong Duan and Xuan Meng, Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Haidian, Beijing 100853, China. E-mail: (Duan WD), (Meng X)
| | - Weidong Duan
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- Address correspondence to:Weidong Duan and Xuan Meng, Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Haidian, Beijing 100853, China. E-mail: (Duan WD), (Meng X)
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Dauvillée J, Ingargiola I, Jouret M, Biard JM, Steenhaut P, Bernard P. Fetal umbilical-systemic shunt with a positive issue. J Gynecol Obstet Hum Reprod 2019; 49:101656. [PMID: 31760176 DOI: 10.1016/j.jogoh.2019.101656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
Abstract
We herein report the case of abnormal umbilical-venous return in which the antenatal ultrasound enabled us to establish the diagnosis of umbilical-systemic shunt (Type 1 according to Achiron (Achiron and Kivilevitch, 2016)). Due to the concomitant associations of cardiomegaly, intrauterine growth retardation, oligohydramnios, and left-lobe hypoplasia with agenesis of the intrahepatic umbilical vein - left portal vein - ductus venosus, a poor prognosis (11.1% survival) was to be expected. In spite of development of pulmonary arterial hypertension at birth, which was promptly treated, the evolution was nevertheless good, both on clinical and ultrasound follow-up.
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Affiliation(s)
- Julie Dauvillée
- Université Catholique de Louvain, Service de Gynécologie et d'Obstétrique, Centre Hospitalier de Wallonie Picarde, Rue des Sports 51, 7500 Tournai, Belgium.
| | - Ingrid Ingargiola
- Service de Gynécologie et d'Obstétrique, Centre Hospitalier de Wallonie Picarde, Rue des Sports 51, 7500 Tournai, Belgium
| | - Mathieu Jouret
- Service de Gynécologie et d'Obstétrique, Centre Hospitalier de Wallonie Picarde, Rue des Sports 51, 7500 Tournai, Belgium
| | - Jean-Marc Biard
- Département d'Obstétrique, Cliniques universitaires Saint-Luc Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - Patricia Steenhaut
- Département d'Obstétrique, Cliniques universitaires Saint-Luc Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - Pierre Bernard
- Département d'Obstétrique, Cliniques universitaires Saint-Luc Avenue Hippocrate 10, 1200 Bruxelles, Belgium
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Yagel S, Cohen SM, Valsky DV. Simplifying imaging of the abdominal fetal precordial venous system. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:571-575. [PMID: 29573303 DOI: 10.1002/uog.19053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/10/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - D V Valsky
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
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Wu H, Tao G, Cong X, Li Q, Zhang J, Ma Z, Zhang Z. Prenatal sonographic characteristics and postnatal outcomes of umbilical-portal-systemic venous shunts under the new in-utero classification: A retrospective study. Medicine (Baltimore) 2019; 98:e14125. [PMID: 30633228 PMCID: PMC6336581 DOI: 10.1097/md.0000000000014125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An in-utero re-classification of umbilical-portal-systemic venous shunt (UPSVS) has recently been proposed. We retrospectively reviewed the sonograms of a large cohort of fetuses, identified and analyzed UPSVS cases, and presented the prenatal sonographic characteristics, birth outcomes, and follow-up results following the new classification system.Sonograms and clinical data of all participants who visited our departments from April 2016 to July 2018 were retrospectively reviewed. Identified cases of UPSVS were analyzed according to the new classification: Type I: umbilical-systemic shunt (USS); Type II: ductus venosus-systemic shunt (DVSS); Type IIIa: intrahepatic portal-systemic shunt (IHPSS) and Type IIIb: extrahepatic portal-systemic shunt (EHPSS). Postnatal follow-ups ranged from 3 months to 1 year.A total of 10 UPSVS cases were identified in 61,082 fetuses: 4 with Type I, 3 with Type II and 3 with Type IIIa. All 4 cases of USS had complete agenesis of the portal venous system, and had the umbilical vein drained into the inferior vena cava. Two USS cases also had trisomy 21. Pregnancy was terminated in all cases with a Type I shunt. Two fetuses with DVSS had normal portal venous system and were born full term. The pregnancy of 1 DVSS case was terminated due to the detection of trisomy 21. Three cases were IHPSS with full-term birth. One had chromosomal abnormality and 1 had surgery to repair the shunt 12-days post birth. In the 2 cases that did not receive repair surgery, sonographic examination revealed the portal-hepatic venous shunt was not closed at the 6-month follow-up period. However, the 1 case that had repair surgery appeared healthy at the 3-month follow-up period.UPSVS is extremely rare. Type I shunts have the poorest prognosis, and the presence of the intrahepatic portal venous system is key to live birth in UPSVS regardless of types. Chromosomal abnormalities and other organ anomalies can occur in any types of UPSVS. Therefore, karyotyping and examination of other organs should be performed once UPSVS is detected.
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Affiliation(s)
- Haifang Wu
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Guowei Tao
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Xiang Cong
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Qi Li
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
- Medical School of Shandong University, Jinan
| | - Jing Zhang
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
- Medical School of Shandong University, Jinan
| | - Zhe Ma
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan
| | - Zhonglu Zhang
- Department of Ultrasound, the Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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Pacheco D, Brandão O, Montenegro N, Matias A. Ductus venosus agenesis and fetal malformations: what can we expect? - a systematic review of the literature. J Perinat Med 2018; 47:1-11. [PMID: 29949516 DOI: 10.1515/jpm-2018-0163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/05/2018] [Indexed: 11/15/2022]
Abstract
Background The ductus venosus agenesis (DVA) is a rare condition with a variable prognosis that relies partly on the presence of associated conditions. The purpose of our study was to analyze the literature regarding the post-natal outcome of fetuses with DVA associated with fetal malformations, in order to discuss the best management options for couples. Methods We performed a systematic review of the literature of MEDLINE and SCOPUS electronic databases in a 25-year period from 1992 to September 2017. Methods We found 340 cases of DVA associated with fetal abnormalities. The most common chromosomal abnormalities were: monosomy X (12/48, 25%), trisomy 21 (11/48, 22.9%) and trisomy 18 (6/48, 12.5%). From the 340 cases with DVA, in 31 cases the umbilical venous shunt type was not reported. Of the fetuses, 60.8% (188/309) had an extrahepatic umbilical venous drainage while 39.2% (121/309) presented an intrahepatic connection. The DVA was associated in 71 cases (23.0%) with cardiac abnormalities, in 82 cases (26.5%) with extracardiac abnormalities and in 85 cases (27.5%) with both cardiac and extracardiac abnormalities. Conclusion DVA associated with both cardiac and extracardiac malformations may confer a poorer fetal outcome, a clinically relevant fact that should clarify what can be expected from this entity and help prenatal counseling.
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Affiliation(s)
- Diana Pacheco
- Faculty of Medicine, University of Porto, Porto, Portugal, Tel.: +351938619352
- Hospital S. João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Otília Brandão
- Department of Pathology, Centro Hospitalar de S. João, Porto, Portugal
| | - Nuno Montenegro
- Department of Obstetrics and Gynaecology, Centro Hospitalar de S. João, Faculty of Medicine, EPIUnit, University of Porto, Porto, Portugal
| | - Alexandra Matias
- Department of Obstetrics and Gynaecology, Centro Hospitalar de S. João, Faculty of Medicine, University of Porto, Porto, Portugal
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Absent Ductus Venosus Associated with Partial Liver Defect. Case Rep Obstet Gynecol 2018; 2018:6591025. [PMID: 30009066 PMCID: PMC6020480 DOI: 10.1155/2018/6591025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/23/2018] [Indexed: 11/17/2022] Open
Abstract
Absent ductus venosus (ADV) is a rare vascular anomaly. We describe a fetus/neonate with ADV with a partial liver defect. A 41-year-old woman was referred to our institute because of fetal cardiomegaly detected by routine prenatal ultrasound, which revealed absence of ductus venosus with an umbilical vein directly draining into the right atrium, consistent with extrahepatic drainage type of ADV. She vaginally gave birth to a 3,096-gram male infant at 38 weeks of gestation. Detailed ultrasound examination revealed a defect of the hepatic rectangular leaf at half a month postnatally. He showed normal development at 1.5 years of age with the liver abnormality and a Morgagni hernia. Liver morphological abnormality should also be considered as a complication of ADV.
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Garcia-Delgado R, Garcia-Rodriguez R, Romero Requejo A, Armas Roca M, Obreros Zegarra L, Medina Castellano M, Garcia Hernandez JA. Echographic features and perinatal outcomes in fetuses with congenital absence of ductus venosus. Acta Obstet Gynecol Scand 2017; 96:1205-1213. [PMID: 28574580 DOI: 10.1111/aogs.13176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/25/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the echographic features and perinatal outcomes of fetuses with absence of ductus venosus. MATERIAL AND METHODS Retrospective review of 10 cases with absence of ductus venosus diagnosed by prenatal ultrasonography between January 2014 and February 2016 at a single referral center. Prenatal findings, umbilical shunting type, perinatal outcomes, and autopsy reports were reviewed. RESULTS A total of 11 491 fetuses underwent a first- and second-trimester screening during the study period. Ten cases of absence of ductus venosus were diagnosed. All of the fetuses presented an extrahepatic shunt: three fetuses from the umbilical vein to the right atrium and the seven remaining fetuses from the umbilical vein to the inferior vena cava. Major structural defects and fetal effusions were detected in six fetuses. There were two cases of chromosomal abnormalities. Five patients underwent legal termination of pregnancy and five decided to carry to term. In two of these, the absence of ductus venosus anomaly was isolated and had a normal outcome. In the remaining three cases, a follow up of the children showed a variety of adverse outcomes. CONCLUSIONS The absence of ductus venosus is associated with high rates of adverse perinatal outcomes. The prognosis for this group of anomalies depends on the additional findings with targeted ultrasound. This pathology should lead to a detailed anatomical study and affected fetuses should be closely monitored for signs of congestive heart failure.
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Affiliation(s)
- Raquel Garcia-Delgado
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Raquel Garcia-Rodriguez
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Azahar Romero Requejo
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Marta Armas Roca
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Luciana Obreros Zegarra
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Margarita Medina Castellano
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Jose A Garcia Hernandez
- Department of Obstetrics and Gynecology, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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Francois B, Lachaux A, Gottrand F, De Smet S. Prenatally diagnosed congenital portosystemic shunts. J Matern Fetal Neonatal Med 2017; 31:1364-1368. [DOI: 10.1080/14767058.2017.1315093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bérengère Francois
- Service de réanimation néonatale, Hôpital Archet, CHU de Nice, Nice, France
| | - Alain Lachaux
- Service d’hépatologie, gastro-entérologie et nutrition pédiatrique, Hôpital Femme-Mère-Enfant, CHU Lyon, Lyon, France
| | - Fréderic Gottrand
- Service d’hépatologie, gastro-entérologie et nutrition pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France
| | - Stéphanie De Smet
- Service de réanimation néonatale, Hôpital Archet, CHU de Nice, Nice, France
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Liu J, Song G, Ren W. Abnormal connection of the ductus venosus to a dilated coronary sinus imaged by prenatal echocardiography: Case report: The postnatal coronary sinus dilation caused by fetal venous anomalies. Echocardiography 2017; 34:629. [PMID: 28378352 DOI: 10.1111/echo.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jing Liu
- Department of Obstetrics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Takita H, Hasegawa J, Arakaki T, Hamada S, Tokunaka M, Nakamura M, Matsuoka R, Sekizawa A. Outcomes in the absence of the ductus venosus diagnosed in the first trimester. J Matern Fetal Neonatal Med 2017; 31:253-257. [PMID: 28076990 DOI: 10.1080/14767058.2017.1281241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To clarify the outcomes of the absence of the ductus venosus (DV) diagnosed in fetuses suspected to have a structural abnormality during a morphological assessment in the first trimester. METHODS Infants in whom ultrasound fetal morphological assessments were attempted in the first trimester (11 to 13-6 weeks of gestation) and who were subsequently delivered between 2013 and 2015 at Showa University Hospital were enrolled. In cases in which the absence of the DV was diagnosed in the first trimester, the prognosis was assessed. RESULTS First-trimester ultrasound screening was performed in a total of 2610 cases between 2013 and 2015. Fetal edema (n = 38), hydrops (n = 16), abnormal four-chamber view findings (n = 2), and tricuspid regurgitation (n = 1) were observed in a total of 52 cases (2.0%). In 4 of the 52 cases with abnormal ultrasound findings, the absence of the DV was detected. CONCLUSION If fetal edema or hydrops in early pregnancy is found without any other structural abnormalities, not only chromosomal abnormalities should be suspected but also an evaluation for the absence of the DV should be included. In addition, absence of the DV with fetal edema may be associated with the outcomes of cardiac dysfunction, chromosome abnormalities, and intrauterine sudden death. Severe fetal edema is associated with a poor prognosis, and the family must be carefully informed of the potential outcomes.
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Affiliation(s)
- Hiroko Takita
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Junichi Hasegawa
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Tatsuya Arakaki
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Shoko Hamada
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Mayumi Tokunaka
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Masamitsu Nakamura
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Ryu Matsuoka
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
| | - Akihiko Sekizawa
- a Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan
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DeVore GR, Tabsh K, Polanco B, Satou G, Sklansky M. Fetal Heart Size: A Comparison Between the Point-to-Point Trace and Automated Ellipse Methods Between 20 and 40 Weeks' Gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2543-2562. [PMID: 27738291 DOI: 10.7863/ultra.16.02019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/13/2016] [Accepted: 03/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate whether the global area and circumference of the heart varies between two measurement techniques: the point-to-point trace and the electronic ellipse methods. METHODS The epicardial border of the 4-chamber view was measured in 200 fetuses between 20 and 40 weeks' gestation, from which the area and circumference using the point-to-point trace and electronic ellipse were measured. Analysis of variance, correlation, and regression analysis using fractional polynomials and 7 independent variables (head circumference, biparietal diameter, abdominal circumference, femur length, estimated fetal weight, mean ultrasound gestational age, and last menstrual period gestational age) were performed. RESULTS The correlation between the mean ultrasound gestational age and last menstrual period gestational age was 0.9880 (5% confidence limit, 0.9716; 95% confidence limit, 0.9880), with an R2 of 0.9762. The R2 value for the 7 independent variables regressed against the area and circumference using the point-to-point trace and electronic ellipse methods ranged between 0.885 and 0.965. Comparison of Z scores between this study and previous publications demonstrated that there were differences and similarities, depending on whether the area or circumference was measured. CONCLUSIONS This study shows high R2 values when comparing measurements of the area and circumference against 7 independent variables, irrespective of whether the point-to-point trace or the electronic ellipse method was used to obtain the measurements. A calculator to evaluate the area and circumference is provided, using 7 independent variables from which Z scores and percentiles for individual measurements can be computed.
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Affiliation(s)
- Greggory R DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Kareem Tabsh
- Department of Obstetrics and Gynecology, Kern Medical Center, Bakersfield, California USA
| | - Bardo Polanco
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California USA
| | - Gary Satou
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California USA
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Moaddab A, Tonni G, Grisolia G, Bonasoni MP, Araujo Júnior E, Rolo LC, Prefumo F, de la Fuente S, Sepulveda W, Ayres N, Ruano R. Predicting outcome in 259 fetuses with agenesis of ductus venosus - a multicenter experience and systematic review of the literature (.). J Matern Fetal Neonatal Med 2016; 29:3606-14. [PMID: 26809266 DOI: 10.3109/14767058.2016.1144743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate prenatal predictors of postnatal survival in fetuses with agenesis of ductus venosus (ADV). METHODS This retrospective study reviewed our experience and the literature between 1991 and 2015. Prenatal findings were evaluated and perinatal morbidity and mortality was documented. RESULTS A total of 259 cases were included in the present analysis from our centers and 49 published studies (15 patients from our retrospective cohort review and 244 from literature review). The intrahepatic and extrahepatic shunts were present in 32.0% (73/226) and 67.7% (153/226), respectively. Cardiomegaly (n = 64/259, 24.7%), hydrops (n = 31/259, 12.0%) and amniotic fluid abnormalities (n = 22/259, 8.5%) were among the most frequent initial ultrasound findings. One hundred and forty-seven fetuses (56.8%) had ADV without structural anomalies while 112 (43.2%) had associated anomalies (cardiac anomalies (n = 66), extra-cardiac anomalies (n = 19) and both cardiac and extra-cardiac anomalies (n = 27)). The mean gestational age (GA) at ultrasound diagnosis was 22.9 ± 6.9 weeks while the mean GA at delivery was 34 ± 7.5 weeks. The overall neonatal survival was 57.1% (n = 148/259). The following factors were associated with survival: advanced maternal age, earlier GA at diagnosis, prematurity, increased nuchal translucency, pericardial effusion, associated cardiac defects (especially AVSD), chromosomal abnormalities, hydrops, hygroma and limb anomalies. CONCLUSION Fetal hydrops, the presence of associated congenital anomalies and premature delivery are associated with poor prognosis in fetuses with ADV.
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Affiliation(s)
- Amirhossein Moaddab
- a Department of Obstetrics and Gynecology , Texas Children's Hospital Fetal Center and Baylor College of Medicine , Houston , TX , USA
| | - Gabriele Tonni
- b Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL , Reggio Emilia , Italy
| | - Gianpaolo Grisolia
- c Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, "Carlo Poma" Hospital , Mantua , Italy
| | - Maria Paola Bonasoni
- d Pathology Service, IRCCS Arcispedale "Santa Maria Nuova" , Reggio Emilia , Italy
| | - Edward Araujo Júnior
- e Department of Obstetrics , Paulista School of Medicine - São Paulo Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Lilliam Cristine Rolo
- e Department of Obstetrics , Paulista School of Medicine - São Paulo Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
| | - Federico Prefumo
- f Department of Obstetrics and Gynecology , University of Brescia , Brescia , Italy
| | | | - Waldo Sepulveda
- g Fetalmed - Maternal Fetal Diagnostic Center , Santiago , Chile , and
| | - Nancy Ayres
- h Department of Pediatric Cardiology , Texas Children's Hospital Fetal Center and Baylor College of Medicine , Houston , TX , USA
| | - Rodrigo Ruano
- a Department of Obstetrics and Gynecology , Texas Children's Hospital Fetal Center and Baylor College of Medicine , Houston , TX , USA
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Berg C, Strizek B. Re: Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance. R. Achiron and Z. Kivilevitch. Ultrasound Obstet Gynecol 2016; 47: 739-747. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:672-673. [PMID: 27256656 DOI: 10.1002/uog.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Berg
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
- Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - B Strizek
- Division of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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Achiron R, Kivilevitch Z. Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:739-747. [PMID: 25988346 DOI: 10.1002/uog.14906] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/10/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To review our experience with fetal umbilical-portal-systemic venous shunts (UPSVS), to devise an in-utero classification system, and to analyze their clinical and prognostic characteristics. METHODS This was a retrospective review of cases of UPSVS examined at an academic tertiary referral center over the 14-year period from 2001 to 2014 inclusive. The anatomical origin and drainage of the fetal umbilical, portal, ductus venosus and hepatic venous systems, and the integrity of the intrahepatic portal venous system (IHPVS), were assessed using two- and three-dimensional color Doppler sonography. Fetomaternal clinical characteristics and long-term outcome were investigated by means of medical files, imaging documentation and telephone interviews with the mothers. RESULTS Forty-four cases with UPSVS were reviewed. Prenatal classification was based on the anatomical origin of the shunt (umbilical, portal or ductal), with cases classified into four types: Type I, umbilical-systemic shunt (n = 9 (20.4%)); Type II, ductus venosus-systemic shunt (n = 19 (43.2%)); and Type III, portal-systemic shunt, divided into two subtypes: Type IIIa, intrahepatic portal-systemic shunt (n = 12 (27.2%)) and Type IIIb, extrahepatic portal-systemic shunt (n = 4 (9.1%)). Each type presented particular clinical and prognostic characteristics. The most important favorable prognostic factors were absence of associated major malformation and presence of the IHPVS. Thus, Type IIIa (intrahepatic portal-systemic shunt) had the best outcome. CONCLUSIONS Fetal UPSVS are anomalies with a broad spectrum of manifestations and prognoses. Accurate mapping of the IHPVS is paramount for optimizing prenatal counseling and postnatal care. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Achiron
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Kivilevitch
- Maccabi Health Services, Ultrasound Unit, Negev Medical Center, Be'er Sheva, Israel
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Faiola S, Bulfamante G, Napolitano M, Mastroianni C, Munari AM, Lanna M, Rustico M. Prenatal diagnosis of extrahepatic umbilicosystemic shunt: a new variant? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:381-383. [PMID: 25809986 DOI: 10.1002/uog.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Affiliation(s)
- S Faiola
- Department of Obstetrics, Fetal Therapy Unit, Children's Hospital V. Buzzi, Milan, Italy
| | - G Bulfamante
- Department of Health Sciences, Unit of Pathology, San Paolo Hospital Medical School, University of Milano, Milan, Italy
| | - M Napolitano
- Paediatric Radiology, Children's Hospital V. Buzzi, Milan, Italy
| | - C Mastroianni
- Department of Obstetrics, Fetal Therapy Unit, Children's Hospital V. Buzzi, Milan, Italy
| | - A M Munari
- Paediatric Radiology, Children's Hospital V. Buzzi, Milan, Italy
| | - M Lanna
- Department of Obstetrics, Fetal Therapy Unit, Children's Hospital V. Buzzi, Milan, Italy
| | - M Rustico
- Department of Obstetrics, Fetal Therapy Unit, Children's Hospital V. Buzzi, Milan, Italy
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29
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Yagel S, Cohen SM, Valsky DV, Shen O, Lipschuetz M, Messing B. Systematic examination of the fetal abdominal precordial veins: a cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:578-583. [PMID: 24919785 DOI: 10.1002/uog.13444] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/21/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Examination of the fetal venous system is a necessary part of complete fetal organ scanning to confirm landmark anatomy, such as the ductus venosus and course of the umbilical veins, and, whenever cardiovascular anomalies are identified, to exclude associated anomalous development of the fetal veins. We aimed to develop a protocol for systematic examination of the fetal venous system during midtrimester targeted organ scanning. METHODS We included low-risk women with a singleton fetus presenting between January 2011 and June 2013 to our center for routine midtrimester (20-24 weeks) targeted organ scanning. Imaging of the venous system was added to the booked scan and comprised two-dimensional color Doppler scanning of the fetal abdomen in three discrete planes, two transverse and one longitudinal. The more caudal plane was obtained in a ventral or lateral transverse abdominal plane to image the umbilical vein, left portal vein, portal sinus, anterior right portal vein, posterior right portal vein, main portal vein and splenic vein and artery. Moving cephalad, a ventral or lateral transverse plane was obtained to image the right, middle and left hepatic veins and inferior vena cava (IVC). Finally, a longitudinal anteroposterior plane showed the umbilical vein, ductus venosus, IVC and left hepatic vein. In some cases the pulsed Doppler waveform of a given target vessel was also examined. Three-dimensional/4D ultrasound was applied as necessary, when anomalous cases were encountered. RESULTS We examined 1810 women. Their body mass index ranged from 19 to 40 (mean, 24.7). In 38 (2.1%) women, the target anatomy was not visualized satisfactorily owing to maternal body habitus. A T-shaped configuration of the portal system vessels was observed in 63% of cases, an X-shaped configuration in 25% and an H-shaped configuration in 12%. During the study period, 24 congenital anomalies of the precordial venous system were diagnosed: nine cases of persistent right umbilical vein, seven of agenesis of the ductus venosus, five of anomalous portal venous drainage and three of interrupted IVC with azygos continuation. CONCLUSIONS Examination of the fetal venous system is feasible with the application of three abdominal planes. While a venous system scan is not practicable as part of a screening-level examination, mastery of the normal anatomy is an essential part of the professional knowledge base, in order to provide ready and complete scanning of the system in cases of suspected anomalies or disordered cardiac function.
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Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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30
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Lei W, Ying Z, Ailu C, Xiaoguang W. Evaluation of normal fetal ductus venosus using B-flow imaging with spatiotemporal image correlation and traditional color Doppler echocardiography. Echocardiography 2014; 32:325-31. [PMID: 25323109 DOI: 10.1111/echo.12658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the feasibility of using four-dimensional echocardiography with B-flow and spatiotemporal image correlation (4DBF-STIC) imaging technology to detect fetal ductus venosus (DV), and establish the normal reference range for the ductus venosus diameter at 18-40 weeks gestation. METHODS This was a prospective observational study to detect the DV in 354 normal fetuses at 18-40 weeks of gestation using color Doppler echocardiography (CDE) and 4DBF-STIC imaging. CDE was performed on an oblique transverse plane of the fetal abdomen, with scanning around the long-axis view of the aortic arch. The DV inlet was measured on a two-dimensional gray-scale image of the long-axis view of the DV. Offline analyses of all datasets were performed. RESULTS The inlet diameter of the DV increased with increasing gestational age. There were no gender-related differences in the DV diameter. Data revealed that 4DBF-STIC was the best method to detect the DV between 18 and 29 weeks of gestation. The visualization rate was higher when scanning around the long-axis view of the aortic arch with CDE than when scanning around the oblique transverse plane throughout the gestational period. CONCLUSIONS Scanning around the long-axis view of the aortic arch using CDE was best suited for detecting the DV in clinical practice, whereas 4DBF-STIC was a feasible and promising technology to detect the fetal DV before 29 weeks of gestation.
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Affiliation(s)
- Wang Lei
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
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31
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Iliescu DG, Cara ML, Tudorache S, Antsaklis P, Novac LV, Antsaklis A, Cernea N. Agenesis of ductus venosus in sequential first and second trimester screening. Prenat Diagn 2014; 34:1099-105. [DOI: 10.1002/pd.4434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 11/11/2022]
Affiliation(s)
- D. G. Iliescu
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - M. L. Cara
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - S. Tudorache
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - P. Antsaklis
- Department of Obstetrics and Gynecology; University of Athens; Athens Greece
| | - L. V. Novac
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
| | - A. Antsaklis
- Department of Obstetrics and Gynecology; University of Athens; Athens Greece
| | - N. Cernea
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit; University of Medicine and Pharmacy Craiova; Craiova Romania
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32
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Isolated Absent Ductus Venosus with Intrahepatic Shunt: Case Report and Review of Literature. JOURNAL OF FETAL MEDICINE 2014. [DOI: 10.1007/s40556-014-0016-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Iliescu DG, Tudorache S, Cernea D. Agenesis of ductus venosus with complex intra- and extrahepatic umbilical drainage. J Obstet Gynaecol Res 2014; 40:1163-4. [PMID: 24698023 DOI: 10.1111/jog.12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dominic G Iliescu
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Unit, University of Medicine and Pharmacy Craiova, Dolj, Romania
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34
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Hofmann SR, Heilmann A, Häusler HJ, Kamin G, Nitzsche KI. Agenesis of the ductus venosus-A case with favorable outcome after early signs of cardiac failure. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:187-190. [PMID: 23475499 DOI: 10.1002/jcu.21917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 02/22/2012] [Indexed: 06/01/2023]
Abstract
Absence of the ductus venosus (ADV) is a rare vascular anomaly. Its prognosis depends on the pathway of the umbilical flow to the systemic venous circulation, and the presence or absence of associated structural or chromosomal anomalies, sometimes resulting in hydrops fetalis. In cases with isolated ADV in the absence of associated anomalies, survival rates are as high as 85%, depending on the shunt situation. Here, we report a patient with ADV and extrahepatic umbilical vein drainage with favorable outcome after intrauterine reversal of early signs of cardiac failure. Diagnosis was made after the appearance of moderate cardiomegaly in the 25th gestational week. Thus, in the case of cardiomegaly with or without further signs of cardiac failure, ultrasound imaging of the venous duct should be considered.
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Affiliation(s)
- Sigrun R Hofmann
- Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
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Thomas JT, Petersen S, Cincotta R, Lee-Tannock A, Gardener G. Absent ductus venosus - outcomes and implications from a tertiary centre. Prenat Diagn 2012; 32:686-91. [DOI: 10.1002/pd.3889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 03/20/2012] [Accepted: 03/25/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Joseph T. Thomas
- Centre for Maternal Fetal Medicine; Mater Health Services; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - Scott Petersen
- Centre for Maternal Fetal Medicine; Mater Health Services; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - Robert Cincotta
- Centre for Maternal Fetal Medicine; Mater Health Services; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - Alison Lee-Tannock
- Centre for Maternal Fetal Medicine; Mater Health Services; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - Glenn Gardener
- Centre for Maternal Fetal Medicine; Mater Health Services; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
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Thubert T, Levaillant JM, Stos B, Benachi A, Picone O. Agenesis of the ductus venosus: three-dimensional power Doppler reconstruction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:118-120. [PMID: 22125204 DOI: 10.1002/uog.10155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- T Thubert
- AP-HP, Université Paris Sud, Hôpital Antoine Béclère, Clamart, France
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