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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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Mori H, Kawasaki Y, Murakami Y, Fujino M, Sasaki T, Nakamura K, Yoshida Y, Suzuki T, Ehara E. Agenesis of the venous duct with abnormal return of the umbilical vein into the superior vena cava: A case report. Echocardiography 2022; 39:1142-1145. [DOI: 10.1111/echo.15423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/25/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hidehiro Mori
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
| | - Yuki Kawasaki
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
| | - Yosuke Murakami
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
| | - Mitsuhiro Fujino
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
| | - Takeshi Sasaki
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
| | - Kae Nakamura
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
| | - Yoko Yoshida
- Division of Pediatric Electrophysiology Osaka City General Hospital Osaka Japan
| | - Tsugutoshi Suzuki
- Division of Pediatric Electrophysiology Osaka City General Hospital Osaka Japan
| | - Eiji Ehara
- Division of Pediatric Cardiology Osaka City General Hospital Osaka Japan
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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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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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Baller SE, Reinehr M, Haslinger C, Restin T, Fauchère JC. Case report of neonatal ductus venosus atresia. J Neonatal Perinatal Med 2021; 14:307-312. [PMID: 32925113 DOI: 10.3233/npm-190398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In the fetus, the ductus venosus (DV) connects the umbilical vein and the portal veins to the inferior vena cava in order to bypass the high-resistance hepatic vascular network. Via the Eustachian valve, the DV directs umbilical venous blood with the highest oxygen content preferentially towards the myocardium and the brain. An absence (agenesis) or a secondary obliteration of an initially normally developed DV (atresia) is associated with various shunt types and may lead to severe hydrops. CASE REPORT A routine check-up of a healthy 34-year-old woman at 27 5/7 wks GA revealed a severe hydrops fetalis with pleural effusions and ascites. After birth at 28 0/7 wks GA, the bilateral pleural effusions needed drainage via thoracic drains. Arterial hypotension was initially treated with volume replacement and dopamine, later on adrenaline and hydrocortisone were added. The initial echocardiography showed normal anatomic structures and normal bi-ventricular function. Despite maximal intensive care treatment, a global respiratory and cardiovascular insufficiency developed. The girl died on fourth day of life. At autopsy, a secondary atresia of the DV was identified, and moreover a pathogenic de novo heterozygous mutation in the KRAS gene was found in the chorion biopsy probe. DISCUSSION For all cases of non-haemolytic hydrops fetalis, a prenatal or postnatal sonography with Doppler examination of the venous system and of the heart should be performed. Furthermore, testing for RASopathies should be recommended especially in presence of increased nuchal translucency thickness and polyhydramnios.
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Affiliation(s)
- S-E Baller
- Clinic of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - M Reinehr
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - C Haslinger
- Clinic of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - T Restin
- Clinic of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - J-C Fauchère
- Clinic of Neonatology, University Hospital Zurich, Zurich, Switzerland
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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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Favilli S, Prandstraller D, Spaziani G, Calabri GB, Lombardi M, Balducci A, Vairo U. Age-related issues: From fetus to adolescent. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ayerza Casas A, López Ramón M, Pérez Pérez P, Rite Gracia S, Palanca Arias D, Jiménez Montañés L. Evolución cardiológica postnatal y factores asociados a la agenesia de ductus venoso de diagnóstico prenatal. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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13
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Maruotti GM, Saccone G, Ciardulli A, Mazzarelli LL, Berghella V, Martinelli P. Absent ductus venosus: case series from two tertiary centres. J Matern Fetal Neonatal Med 2017. [DOI: 10.1080/14767058.2017.1344637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrea Ciardulli
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Laura Letizia Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
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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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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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16
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Phillis M, Garcia AV, Jelin EB. A Morgagni hernia with an absent ductus venosus: An unusual case causing unusual consequences. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Varied Presentations of Absent Ductus Venosus, Their Associations, and Outcomes. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0064-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Klein T, Semaan A, Kellner M, Ritgen J, Boemers T, Stressig R. Coincidence of congenital left-sided diaphragmatic hernia and ductus venosus agenesis: Relation between altered hemodynamic flow and lung-to-head-ratio? JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Agenesis of the venous duct: two cases of extrahepatic drainage of the umbilical vein and extrahepatic portosystemic shunt with a review of the literature. Cardiol Young 2015; 25:208-17. [PMID: 24848245 DOI: 10.1017/s1047951114000729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Agenesis of the venous duct is a rare congenital anomaly resulting in abnormal drainage of the umbilical vein into the foetal venous circulation. The clinical presentation and prognosis is variable, and may depend on the specific drainage pathways of the umbilical vein. We present two foetuses with agenesis of the venous duct, both associated with a postnatal portosystemic shunt, but with markedly different postnatal clinical courses. We also review all previously reported cases to better characterise this foetal disorder and the prognosis.
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20
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Firdouse M, Agarwal A, Pindiprolu B, Mondal T. Two ductus venosus: a previously unreported anomaly. J Ultrasound 2014; 17:293-6. [PMID: 25368687 DOI: 10.1007/s40477-014-0086-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/17/2014] [Indexed: 10/25/2022] Open
Abstract
In early fetal life, the ductus venosus (DV) connects the umbilical vein, carrying nutrient-rich and oxygenated blood from the placenta to the inferior vena cava (IVC). We present the first ever case of a fetus with two ductus venosus. The fetus presented with a four-vessel cord and a dilated bowel at 31 weeks of gestation. Ultrasonography showed a persistent right umbilical vein. Echocardiographic investigation revealed normal cardiac anatomy with no major malformations. Two DVs with slightly different Doppler patterns were visualized anastomosing with the IVC. The baby was born uneventfully at 39 weeks of gestation with stable hemodynamics. Assuming every supernumerary umbilical vein should be connected to a DV for balanced circulation, a fetus with supernumerary umbilical veins lacking a corresponding number of DV connections is likely to be predisposed to complications such as hydrops fetalis and poor perinatal outcomes. The possibility of one or more umbilical veins lacking a DV connection warrants significant attention and regular monitoring from feto-maternal specialists, given the severity of the associated morbidity and mortality.
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Affiliation(s)
- Mohammed Firdouse
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; McMaster University, 4077 Tea Garden Circle, Mississauga, ON L5B 2W5 Canada
| | - Arnav Agarwal
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; McMaster University, 252 Macedonia Crescent, Mississauga, ON L5B 3R7 Canada
| | - Bharadwaj Pindiprolu
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; McMaster University, 4371 Alta Court, Mississauga, ON L4Z 1N6 Canada
| | - Tapas Mondal
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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21
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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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22
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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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23
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Oztunc F, Gokalp S, Yuksel MA, Imamoglu M, Madazli R. Absent ductus venosus in the fetus. J OBSTET GYNAECOL 2014; 34:741. [PMID: 25010332 DOI: 10.3109/01443615.2014.930105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F Oztunc
- Divison of Pediatric Cardiology, Department of Pediatrics, Cerrahpasa School of Medicine, Istanbul University , Istanbul , Turkey
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24
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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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25
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[Prenatal diagnosis of gallbladder abnormalities: a review]. ACTA ACUST UNITED AC 2014; 43:581-6. [PMID: 24878204 DOI: 10.1016/j.jgyn.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Our objective was to review the possible consequences and management possibilities of fetal gallbladder abnormalities. MEANS AND METHODS A search through publications was conducted using the Pubmed database. RESULT The majority of fetal gallbladder abnormalities are benign (absence, malformation, cholelithiasis, sludge...). When the absence of gallbladder is isolated, biliary tract atresia, that is a rare but severe disease, must be evoked. CONCLUSION An extensive morphological analysis of the fetus is required in cases with gallbladder abnormalities. An amniocentesis for caryotype analysis must be proposed when an absent gallbladder is associated with other fetal abnormalities and in all cases of absent gallbladder for digestive enzymes evaluation to rule out a biliary atresia.
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26
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Jowett V, Paramasivam G, Seale A, Choudhry M, Yates R, Gardiner H. Diaphragmatic hernia: a postnatal complication of anomalous drainage of the umbilical vein. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:589-591. [PMID: 23288807 DOI: 10.1002/uog.12381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 06/01/2023]
Abstract
The ductus venosus (DV) connects the portal venous system to the inferior vena cava. Rarely, the umbilical venous drainage is anomalous, either connecting to the portal sinus within the liver or having an extrahepatic connection, bypassing the liver and draining to one of a variety of sites, including to the heart directly. Prenatally, there is a recognized association of anomalous umbilical venous drainage with aneuploidy and other structural malformations. The fetus may also develop right heart failure because of unregulated volume loading. We report the postnatal development of diaphragmatic hernia in three fetuses with absent DV and umbilical venous drainage to the right atrium directly in two cases and to the coronary sinus in the third. In all fetuses, the abnormality was well-tolerated in pregnancy, with only a modest degree of right heart dilatation. All three neonates underwent repair of the diaphragmatic hernia and made a good recovery.
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Affiliation(s)
- V Jowett
- Imperial College, Reproductive Biology at Queen Charlotte's and Chelsea Hospital, London, UK.
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27
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Gore S, Smith M, Nessling C. Agenesis of the Ductus Venosus With Extrahepatic Umbilical Vein Connection Into the Right Atrium. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313480848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Agenesis of the ductus venosus is a rare anomaly that was first reported in literature within the past decade. Color/Doppler sonography is an important tool for mapping blood flow in determining this aberrant anastomosis. Careful observation of the fetus for signs of congestive heart failure can lead to a positive outcome. In the following case, cardiomegaly was detected and digoxin was introduced, which arrested progression into congestive heart failure.
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Affiliation(s)
- Sharon Gore
- Maternal Fetal Medicine of SW Florida, Fort Myers, FL, USA
| | - Melissa Smith
- Maternal Fetal Medicine of SW Florida, Fort Myers, FL, USA
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28
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Corbacioglu A, Aslan H, Dagdeviren H, Ceylan Y. Prenatal diagnosis of abnormal course of umbilical vein and ductus venosus agenesis: report of three cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:590-593. [PMID: 22362124 DOI: 10.1002/jcu.21883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023]
Abstract
Ductus venosus connecting the portal and embryonic venous circulation into the inferior vena cava has a crucial role in fetal circulation. The absence of ductus venosus is a rare anomaly, in which the umbilical vein connection to the venous system may be extrahepatic, bypassing the liver or intrahepatic via the portal venous system. We report three cases of ductus venosus agenesis with associated anomalies. In two of them the connection was directly to the right atrium, whereas the umbilical vein drained to the left internal iliac artery in the third case.
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Affiliation(s)
- Aytul Corbacioglu
- Istanbul Kanuni Sultan Suleyman Research and Teaching Hospital Department of Obstetrics and Gynecology, Istanbul, Turkey
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29
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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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30
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Bekdache GN, Hamdan MA, Begam MA, Chedid F, Tamim MM, Mirghani H. Prenatal diagnosis of extrahepatic umbilicoportosystemic shunt: impact on postnatal management. J OBSTET GYNAECOL 2011; 31:542-3. [DOI: 10.3109/01443615.2011.580395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Dzialowski EM, Sirsat T, van der Sterren S, Villamor E. Prenatal cardiovascular shunts in amniotic vertebrates. Respir Physiol Neurobiol 2011; 178:66-74. [PMID: 21513818 DOI: 10.1016/j.resp.2011.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 04/05/2011] [Accepted: 04/07/2011] [Indexed: 12/01/2022]
Abstract
During amniotic vertebrate development, the embryo and fetus employ a number of cardiovascular shunts. These shunts provide a right-to-left shunt of blood and are essential components of embryonic life ensuring proper blood circulation to developing organs and fetal gas exchanger, as well as bypassing the pulmonary circuit and the unventilated, fluid filled lungs. In this review we examine and compare the embryonic shunts available for fetal mammals and embryonic reptiles, including lizards, crocodilians, and birds. These groups have either a single ductus arteriosus (mammals) or paired ductus arteriosi that provide a right-to-left shunt of right ventricular output away from the unventilated lungs. The mammalian foramen ovale and the avian atrial foramina function as a right-to-left shunt of blood between the atria. The presence of atrial shunts in non-avian reptiles is unknown. Mammals have a venous shunt, the ductus venosus that diverts umbilical venous return away from the liver and towards the inferior vena cava and foramen ovale. Reptiles do not have a ductus venosus during the latter two thirds of development. While the fetal shunts are well characterized in numerous mammalian species, much less is known about the developmental physiology of the reptilian embryonic shunts. In the last years, the reactivity and the process of closure of the ductus arteriosus have been characterized in the chicken and the emu. In contrast, much less is known about embryonic shunts in the non-avian reptiles. It is possible that the single ventricle found in lizards, snakes, and turtles and the origin of the left aorta in the crocodilians play a significant role in the right-to-left embryonic shunt in these species.
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Affiliation(s)
- Edward M Dzialowski
- Department of Biological Sciences, University of North Texas, Denton, TX 76203, USA.
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32
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Shen O, Valsky DV, Messing B, Cohen SM, Lipschuetz M, Yagel S. Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:184-190. [PMID: 20521238 DOI: 10.1002/uog.7702] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Agenesis of the ductus venosus (ADV) is a rare condition in which there are two variants of umbilical vein drainage: intrahepatic shunt or extrahepatic (portosystemic) shunt. It has been posited that the extrahepatic variant carries a poorer prognosis. However, in the absence of associated anomalies there is still a wide variation in outcome. We evaluated the portal system in cases of ADV and aimed to identify parameters that might predict outcome. METHODS We conducted a retrospective study of cases of ADV with extrahepatic shunt that had been examined in two centers, and collected new cases prospectively. The route of the shunt was depicted using two-dimensional (2D) and three-dimensional (3D) ultrasound imaging. In an attempt to characterize portal system and shunt developmental variations and their possible impact on outcome, the diameter of the shunt was compared with the diameter of the umbilical vein and the entire portal vasculature was assessed. Poor outcome was defined as persistent morbidity or fetal or neonatal death. RESULTS Twenty-two cases of ADV were identified: nine retrospectively and 13 prospectively. Aberrant shunts from the umbilical vein were identified to the right atrium, coronary sinus, inferior vena cava (IVC) and iliac vein. In seven of 22 cases (32%) a wide connection was observed. In six of these seven cases (86%) the outcome was poor, including four with severe associated anomalies and two with hepatic dysfunction. In five of these cases, cardiomegaly with tricuspid regurgitation was observed, as well as underdevelopment of the portal system. In only five of 15 cases with a narrow shunt (33%) was the outcome poor, and in all five cases the poor outcome was related to associated anomalies. CONCLUSION In cases of ADV with extrahepatic shunt, portal system development is impacted by the diameter of the shunt. If the shunt is narrow, the portal system will have developed normally. A wide shunt is associated with underdevelopment or absence of the portal system. In cases of ADV with extrahepatic shunt, prognosis is determined by the severity of associated anomalies, the diameter of the shunt and development of the portal system.
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Affiliation(s)
- O Shen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Staboulidou I, Pereira S, de Jesus Cruz J, Syngelaki A, Nicolaides KH. Prevalence and Outcome of Absence of Ductus Venosus at 11 +0 to 13 +6 Weeks. Fetal Diagn Ther 2011; 30:35-40. [DOI: 10.1159/000323593] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/14/2010] [Indexed: 11/19/2022]
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:93-111. [PMID: 20205158 DOI: 10.1002/uog.7622] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Abstract
An absent ductus venosus is a rare anomaly which results aberrant umbilical venous return. The fetus which is defined here referred to our clinic at 30th gestational week because of cardiomegaly. The diagnosis of ductus venosus agenesis and anomalous umbilical venous return was done by fetal echocardiography. The fetus has two unique features. The drainage of anomalous umbilical vein into the superior vena cava and associated persistent truncus arteriosus have not been reported yet in fetuses with absent ductus venosus.
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Achiron R, Gindes L, Gilboa Y, Weissmann-Brenner A, Berkenstadt M. Umbilical vein anomaly in fetuses with Down syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:297-301. [PMID: 20069683 DOI: 10.1002/uog.7542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe the prevalence of abnormal umbilical vein (UV) anatomy in fetuses with Down syndrome. METHODS This was a retrospective survey covering a 24-month period of fetuses with a genetic diagnosis of Down syndrome following a routine early second-trimester (12-16-week) detailed fetal anomaly scan at a single academic tertiary referral center. In our unit this exam includes fetal umbilicoportal venous system evaluation. RESULTS During the study period, 37 fetuses were diagnosed with Down syndrome and had a detailed early anatomy scan. In four (11%) the detailed early anomaly scan revealed that the UV was connected to the hepatic portion of the inferior vena cava (IVC) at a position lower than its usual site. Their average gestational age at diagnosis was 13 + 6 (range, 11 + 6 to 15 + 2) weeks. Three of the four fetuses had a nuchal translucency thickness of 3-4 mm. In one fetus there was an additional finding of significant tricuspid regurgitation and the one with normal nuchal translucency thickness had an atrioventricular septal defect (atrioventricular canal) and umbilical cord hernia. During the same period three of 2500 (0.12%) fetuses with normal karyotype demonstrated similar anomalous insertion of the UV into the IVC, creating a portocaval shunt which had normal ductus venosus-like Doppler flow in all three cases. The odds ratio for abnormal umbilicoportal venous system in fetuses with Down syndrome compared with the normal population was 107.4 (95% CI, 19.2-637.1). CONCLUSIONS Fetuses with Down syndrome demonstrate an increased prevalence of abnormal connection of the UV to the IVC.
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Affiliation(s)
- R Achiron
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Tanaka A, Kondo Y, Hidaka N, Yumoto Y, Fujita Y, Fukushima K, Wake N. Prenatal features of omphalocele and absent ductus venosus: case with a favorable postnatal outcome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:307-311. [PMID: 20103804 DOI: 10.7863/jum.2010.29.2.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Akiko Tanaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Barseghyan K, Sklansky MS, Paquette LB, Randolph LM, Miller DA. Agenesis of the ductus venosus in a fetus with nonmosaic trisomy 22. Prenat Diagn 2009; 29:901-2. [PMID: 19499517 DOI: 10.1002/pd.2309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Clerici G, Rosati A, Di Renzo GC. Absent ductus venosus associated with skeletal anomalies of the ulna and radius. Prenat Diagn 2009; 30:83-5. [DOI: 10.1002/pd.2390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Achiron R, Gindes L, Kivilevitch Z, Kuint J, Kidron D, Boyanover Y, Yakobson J, Heggesh J. Prenatal diagnosis of congenital agenesis of the fetal portal venous system. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:643-652. [PMID: 19953566 DOI: 10.1002/uog.7460] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe the prenatal diagnosis and review our experience of fetal congenital agenesis of the portal venous system (CAPVS) and to review the current literature on this poorly documented vascular malformation. METHODS This was a retrospective survey covering the 12-year period between 1996 and 2008. The database of a single, large, ultrasonographic tertiary academic referral center in Israel was analyzed and cases with a prenatal diagnosis of CAPVS were identified. All fetuses underwent detailed biometric and structural ultrasound examinations and a precise anatomical description of the fetal umbilical, portal and hepatic venous system was noted, as well as the presence of aberrant vessels, shunt location and the presence or absence of the DV. Results of fetal echocardiography, karyotyping and toxoplasma, rubella, cytomegalovirus and herpes evaluations were determined. Medical records were evaluated. Diagnosis was confirmed by pathology, postmortem venography or neonatal ultrasound or venography. Liveborns were examined by a certified neonatologist and long-term follow-up from pediatric gastroenterology units was determined. RESULTS Nine cases with CAPVS were studied. In all cases an aberrant umbilical-portal vein was the primary indication for detailed portal system evaluation. Five fetuses demonstrated total CAPVS (Type I) and four showed partial agenesis of the portal vein (Type II). Among the five Type I fetuses, there was a shunt from the umbilical vein to the inferior vena cava in three (60%), to the right atrium in one and to the coronary sinus in one. In this group, in only one case could we delineate a common confluence between the splenic vein and the superior mesenteric vein shunting to the inferior vena cava. In four cases termination of pregnancy was performed due to additional findings: one case with hydrothorax, ascites and mitral atresia, one with cleft lip/palate and one with trisomy 21. One case had no additional anomalies, but the parents elected to terminate the pregnancy. All four of the Type II fetuses had a portosystemic shunt: in two cases to the right atrium, in one to the iliac vein and in one to the right hepatic vein. In three, the shunt resolved spontaneously. In only one case was abnormal liver function present over a follow-up period of 2-10 years. CONCLUSION CAPVS can be detected prenatally. An abnormal course of the umbilical vein necessitates prompt sonographic evaluation of the umbilical-portal venous system and meticulous investigation for additional anomalies. Complete CAPVS may be associated with remote clinical consequences of which the parents should be informed. Partial CAPVS has a favorable prognosis.
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Affiliation(s)
- R Achiron
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Kumar N, Uhing MR, Powell M. Congenital absence of ductus venosus: an umbilical catheter with an abnormal path. J Perinatol 2009; 29:646-8. [PMID: 19710659 DOI: 10.1038/jp.2009.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- N Kumar
- Department of Pediatrics, Medical College of Wisconsin, Children's Corporate Center, Milwaukee, WI 53201-1997, USA
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Gindes L, Pretorius DH, Romine LE, Kfir M, D'Agostini D, Hull A, Achiron R. Three-dimensional ultrasonographic depiction of fetal abdominal blood vessels. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:977-988. [PMID: 19643779 DOI: 10.7863/jum.2009.28.8.977] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to identify fetal abdominal vasculature with 3-dimensional (3D) ultrasonography and to describe a systematic method for analysis of volume data sets. METHODS Three-dimensional volumes of the fetal abdomen were acquired prospectively in 30 patients between 15 and 34 weeks' gestation with color Doppler, high-definition (HD) flow, power Doppler, and B-flow imaging. All volumes were analyzed offline by 2 examiners separately. The feasibility of identifying the fetal abdominal blood vessels was analyzed. A standardized approach was applied to identify specific vessels by correlating the images with known anatomic landmarks. RESULTS The volumes were rotated into an anatomic orientation in the multiplanar mode, and then the vessels were identified in the following order: aorta (30 of 30), celiac trunk (29 of 30), superior mesenteric vein (28 of 30 and 26 of 30 for readers 1 and 2, respectively), superior mesenteric artery (29 of 30), left renal artery (25 of 30 and 26 of 30), right renal artery (27 of 30), common iliac arteries (30 of 30), umbilical arteries (26 of 27), external iliac arteries (20 of 22), umbilical vein (29 of 30), ductus venosus (30 of 30), hepatic vein (29 of 30), right portal vein (29 of 30), inferior vena cava (28 of 30), adrenal artery (2 of 30), hepatic artery (24 of 30 and 23 of 30), splenic artery (24 of 30 and 23 of 30), gastric artery (14 of 30 and 9 of 30), splenic vein (19 of 30 and 15 of 30), and renal vein (1 of 30). A step-by-step systematic approach to identify the abdominal vasculature from the ultrasonographic volume data set was developed. CONCLUSIONS Fetal abdominal vessels can be easily visualized when a systematic analysis is performed on 3D data set volumes. Visualization of the vessels was optimal when volumes were acquired with HD flow imaging.
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Affiliation(s)
- Liat Gindes
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel.
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Takeuchi M, Nakayama M, Tamura A, Kitajima H. Hydrops fetalis due to agenesis of the ductus venosus: new hepatic histological features. Pediatr Dev Pathol 2009; 12:239-43. [PMID: 19071968 DOI: 10.2350/07-10-0363.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 11/09/2008] [Indexed: 11/20/2022]
Abstract
We describe the clinical course and autopsy findings of a male infant with hydrops fetalis due to agenesis of the ductus venosus. Fetal echocardiography at 27 weeks in gestation demonstrated hydrops fetalis due to unknown causes. The baby was born at 28 weeks in gestation by emergency caesarean section because of preeclampsia and progressive hydrop fetalis but died immediately at birth. The umbilical vein catheter ran an unusual course: left renal vein and inferior vena cava were opacified after postmortem injection of radiopaque dye into the umbilical vein. The autopsy demonstrated agenesis of the ductus venosus without extrahepatic umbilical venous drainage. The type without extrahepatic venous drainage is rare but shows a favorable outcome in general. However, our findings illustrate that in addition to sinusoidal dilatation, some cases may induce significant medial hypertrophy of portal veins, leading to hydrops fetalis and neonatal demise.
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Affiliation(s)
- Makoto Takeuchi
- Department of Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health.
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Moon SB, Park KW, Jung SE. Abnormal direct entry of the umbilical vein into the portal vein: report of a case. Pediatr Surg Int 2008; 24:1243-5. [PMID: 18791724 DOI: 10.1007/s00383-008-2242-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 10/21/2022]
Abstract
Abnormalities of the intra-abdominal umbilical venous connections are rare congenital vascular anomalies. We report a case of an aneurismal dilatation of an umbilical vein directly connected to the portal vein, vital for the delivery of placental blood in the fetus. A term female newborn presented with a dilated umbilical vein detected by prenatal ultrasound. CT angiography revealed an aneurismal dilatation of a vascular structure, from the umbilical ring to the main portal vein. Follow-up CT angiography showed thrombus progression up to the level of SMV inlet. A laparotomy revealed that the normal course of the umbilical vein was absent. The aneurysm was resected and no thrombus was noted in the aneurysm. Post-operative ultrasound revealed an isolated thrombus at the right main portal vein that resolved spontaneously on the follow-up ultrasound. At the 6-month post-operative follow-up, the baby was well and without complications. Although not evaluated for the presence of a ductus venosus, this anomalous umbilical-portal venous connection might have been associated with an absent ductus venosus.
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Affiliation(s)
- Suk-Bae Moon
- Department of Pediatric Surgery, Seoul National University Children's Hospital, 28 Youngon-dong, Chongno-gu, Seoul, 110-744, South Korea.
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Teixeira LS, Leite J, Castro Viegas MJB, Faria MML, Pires MC, Teixeira HC, Teixeira RC, Pettersen H. Non-influence of fetal gender on ductus venosus Doppler flow in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:12-14. [PMID: 18504786 DOI: 10.1002/uog.5330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Recent findings have suggested that ductus venosus blood flow may be influenced by fetal gender. The aim of this study was to investigate further the influence of fetal gender on ductus venosus Doppler flow in the first trimester. METHODS This was a cross-sectional and retrospective study performed between January 1998 and January 2003. A total of 932 fetuses at between 10 and 14 weeks' gestation were included. The following inclusion criteria were used: singleton gestation; crown-rump length between 39 and 84 mm; and absence of fetal anomalies. The following variables of the ductus venosus were evaluated: peak velocity during ventricular systole (S-wave) and diastole (D-wave); nadir during atrial contraction in late diastole (A-wave); pulsatility index for veins (PIV); peak velocity index for veins (PVIV); and time-averaged maximum velocity (TAMXV). RESULTS Four hundred and forty-eight (48.1%) female and 484 (51.9%) male fetuses were included in the study. Comparing males and females at between 10 and 14 weeks' gestation, there was no statistically significant difference in S-wave, D-wave, A-wave, PIV, PVIV or TAMXV. CONCLUSIONS Our study suggests that fetal gender does not influence ductus venosus blood flow in the first trimester.
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Affiliation(s)
- L S Teixeira
- Serviço de Medicina Fetal-Eccos-Clinica da Imagem, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Taddei F, Signorelli M, Prefumo F, Franceschetti L, Marasini M, Groli C. Prenatal imaging of ductus venosus agenesis using 4D ultrasound with a matrix array transducer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:477-479. [PMID: 18383474 DOI: 10.1002/uog.5281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
This article presents a case report of a 37-week gestational age (GA) female infant (CK) whose first ultrasound at 35 weeks' GA revealed polyhydramnios, fetal ascites, and a possible diaphragmatic hernia. At birth, CK had a grossly distended abdomen, prominent abdominal veins, hepatomegaly, bounding femoral pulses, and generalized edema. Initial imaging identified an absent ductus venosus, absent segment of the inferior vena cava (IVC), and prominent superior vena cava to the right atrium. A computed tomography (CT) scan showed a mass contiguous with the liver causing compression of the IVC. Biopsy confirmed infantile myofibromatosis (IM), an uncommon soft tissue neoplasm that may present at birth or in early infancy. Although rare, this neoplasm is the most common fibrous tumor of infancy. The case of CK was unusual because the solitary IM lesion was in an atypical location; a solitary lesion is not commonly found in the viscera, and solitary lesions are predominant in males. Although lesions are often benign, visceral involvement is associated with high mortality. The cause is unknown, although familial cases have been reported. This article describes the key features of IM, possible treatment options, nursing care, and prognosis for infants with the disease.
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Hajdú J, Marton T, Kozsurek M, Pete B, Csapó Z, Beke A, Papp Z. Prenatal Diagnosis of Abnormal Course of Umbilical Vein and Absent Ductus Venosus – Report of Three Cases. Fetal Diagn Ther 2007; 23:136-9. [DOI: 10.1159/000111594] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 11/10/2006] [Indexed: 12/14/2022]
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Berg C, Thomsen Y, Geipel A, Germer U, Gembruch U. Reversed end-diastolic flow in the umbilical artery at 10-14 weeks of gestation is associated with absent pulmonary valve syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:254-8. [PMID: 17721913 DOI: 10.1002/uog.4098] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine the incidence of reversed end-diastolic flow (REDF) in the umbilical artery in high-risk first-trimester pregnancies and evaluate associated conditions. METHODS This was a prospective evaluation of the umbilical artery Doppler waveforms of 614 consecutive high-risk pregnancies between 10 and 14 weeks of gestation, to determine those with REDF. The associated anomalies and characteristics of these fetuses were then investigated. RESULTS In 278/614 (45.3%) fetuses, there was positive end-diastolic flow in the umbilical artery; in 331/614 (53.9%) end-diastolic flow was absent and in 5/614 (0.8%) there was REDF. Three of the five fetuses with REDF had tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS) and a patent ductus arteriosus, and all three showed signs of cardiac failure, with reversed blood flow in the ductus venosus during atrial systole and generalized skin edema. Another fetus had a large ventricular septal defect and the remaining fetus had agenesis of the ductus venosus. Three fetuses had trisomy 18 and one had trisomy 13. CONCLUSIONS REDF in the umbilical artery is very rare in early pregnancy and mostly occurs in association with major fetal vascular anomalies and cardiac defects, particularly TOF with APVS and patent arterial duct. We propose that the patency of the arterial duct in TOF with APVS leads to heart failure with subsequent demise early in pregnancy. Therefore, the frequent absence of the arterial duct observed in APVS in later pregnancy is more likely to be a result of early selection than a prerequisite for the development of this lesion as has been proposed previously.
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Affiliation(s)
- C Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Germany.
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Acherman RJ, Evans WN, Galindo A, Collazos JC, Rothman A, Mayman GA, Luna CF, Rollins R, Kip KT, Berthody DP, Restrepo H. Diagnosis of absent ductus venosus in a population referred for fetal echocardiography: association with a persistent portosystemic shunt requiring postnatal device occlusion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1077-82. [PMID: 17646370 DOI: 10.7863/jum.2007.26.8.1077] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this series was to assess the incidence, anatomic variants, and implications of an absent ductus venosus (ADV) in patients referred for fetal echocardiography. METHODS We searched our fetal cardiology database for diagnoses of ADV from May 2003 to December 2006. RESULTS During the study period, we performed 1328 fetal echocardiographic examinations in 990 fetuses. We found 6 cases of ADV (6/1000). Indications for fetal echocardiography were cardiomegaly, dilated umbilical or systemic veins, and extracardiac abnormalities. We identified 5 anatomic variants of ADV. In 2 patients, the umbilical vein connected to the systemic venous circulation by way of the portal sinus: via an abnormal venous channel from the portal sinus to the right atrium (case 1) and presumably via hepatic sinusoids to the hepatic veins (case 2). In the remaining 4 patients, the umbilical vein bypassed the portal sinus and the liver and connected to the systemic venous circulation via an abnormal venous channel: from the umbilical vein to the right atrium (case 3), from the umbilical vein to the inferior vena cava (cases 4 and 5), and from the umbilical vein to the right iliac vein (case 6). All patients survived; 2 required cardiovascular intervention. No intervention was required in 3 patients. CONCLUSIONS An ADV should be ruled out in a fetus with unexplained cardiomegaly or dilatation of the umbilical vein, systemic veins, or portal sinus. To our knowledge, prenatal diagnosis of an ADV with an abnormal communication between the portal sinus and the right atrium has not been reported previously. The portosystemic communication persisted after birth and required device occlusion.
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Affiliation(s)
- Ruben J Acherman
- Fetal Cardiology Program, Children's Heart Center, Las Vegas, NV 89109, USA.
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