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Lee JH, Denault AY, Beaubien-Souligny W, Cho SA, Ji SH, Jang YE, Kim EH, Kim HS, Kim JT. Evaluation of Portal, Splenic, and Hepatic Vein Flows in Children Undergoing Congenital Heart Surgery. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00247-1. [PMID: 37183119 DOI: 10.1053/j.jvca.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/30/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Little is known about changes in portal, splenic, and hepatic vein flow patterns in children undergoing congenital heart surgery. This study aimed to determine the characteristics of portal, splenic, and hepatic vein flow patterns using ultrasonography in children undergoing cardiac surgery. DESIGN Single-center, prospective observational study. SETTING Tertiary children's hospital, operating room. PARTICIPANTS Children undergoing cardiac surgery. MEASUREMENT AND MAIN RESULTS The authors obtained ultrasound data from the heart, inferior vena cava, portal, splenic, and hepatic veins before and after surgeries. In the biventricular group, which included children with atrial and ventricular septal defects and pulmonary stenosis (n = 246), the portal pulsatility index decreased from 38.7% to 25.6% (p < 0.001) after surgery. The preoperative portal pulsatility index was significantly higher in patients with pulmonary hypertension (43.3% v 27.4%; p < 0.001). In the single-ventricle group (n = 77), maximum portal vein flow velocities of Fontan patients were significantly lower (13.5 cm/s) compared with that of patients with modified Blalock-Taussig shunt (19.7 cm/s; p = 0.035) or bidirectional cavopulmonary shunt (23.1 cm/s; p < 0.001). The cardiac index was inversely correlated with the portal pulsatility index in the bidirectional cavopulmonary shunt and Fontan circulation. (β = -5.693, r2 = 0.473; p = 0.001) The portal pulsatility index was correlated with splenic venous pulsatility and hepatic venous atrial reverse flow velocity in biventricular and single-ventricle groups. CONCLUSIONS The characteristics of venous Doppler patterns in the portal, splenic, and hepatic veins differed according to congenital heart disease. Further studies are required to determine the association between splanchnic venous Doppler findings and clinical outcomes in this population.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - André Y Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - William Beaubien-Souligny
- Department of Medicine, Nephrology Division, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ultrasound Imaging of the Superior Vena Cava: A State-of-the-Art Review. J Am Soc Echocardiogr 2023; 36:447-463. [PMID: 36754099 DOI: 10.1016/j.echo.2023.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Greater interest in imaging the superior vena cava (SVC) in recent years has arisen because of increased focus on disorders of the right heart; the growing use of transvenous access lines, dialysis catheters, and device leads; and the emergence of right ventricular mechanical circulatory support systems via the transcatheter approach. As a low-pressure venous conduit in the right upper mediastinum, the SVC is prone to compression by various pathologic processes, to invasion by malignancies originating in nearby structures, and to complications arising from intraluminal device leads and indwelling catheters. Computed tomography and magnetic resonance venography are the modalities of choice for structural imaging of the SVC. Ultrasound allows a reasonable, yet less detailed anatomic assessment of this venous conduit. Spectral and color Doppler imaging by ultrasound are the most valuable noninvasive tools for the interrogation of SVC blood flow, a marker of the filling pattern of the right heart. Analysis of the velocity, duration, and direction of the Doppler waveforms and their phasic response to respiration makes it possible to distinguish normal from abnormal flow patterns and offers diagnostic insights into disorders that affect right heart function. The aims of this review are to demonstrate the added value SVC imaging provides during transthoracic and transesophageal echocardiographic studies, to outline its usefulness for the detection and evaluation of structural abnormalities, and to detail the role of spectral Doppler imaging in aiding the diagnosis of various disorders that affect the right heart.
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3
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Croquette M, Puyade M, Montani D, Jutant EM, De Géa M, Lanéelle D, Thollot C, Trihan JE. Diagnostic Performance of Pulsed Doppler Ultrasound of the Common Femoral Vein to Detect Elevated Right Atrial Pressure in Pulmonary Hypertension. J Cardiovasc Transl Res 2023; 16:141-151. [PMID: 35604591 DOI: 10.1007/s12265-022-10276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
Right atrial pressure (RAP) is an important prognostic criterion in pulmonary hypertension (PH). The main goals were to evaluate the following: (i) the accuracy of Doppler assessment of common femoral vein flow waveform to detect elevated RAP and (ii) the diagnostic accuracy of RAP assessed by echocardiography (eRAP). Fifty-seven patients, addressed for right heart catheterization, were included in a retrospective cross-sectional study during a 6-month period. Forty-five patients (78.9%) had PH confirmed by RHC. Elevated RAP was defined by RAP ≥ 10 mmHg. Femoral venous stasis index (FVSI) was highly correlated to RAP on both univariate (p < 0.001) and multivariate analysis (p = 0.003), and showed good diagnostic performances to detect elevated RAP (specificity: 92.3% [80.0-99.3], diagnosis accuracy: 90.4 [77.4-97.3], positive likelihood ratio: 12.5 [3.01-51.97]). Diagnosis accuracy of eRAP was only 51.2% (36.2-66.1). FVSI is independently correlated to RAP and a useful tool to predict elevated RAP in PH patients.
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Affiliation(s)
- Magali Croquette
- Vascular Medicine Unit, Cardio-Vascular Center, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Puyade
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - David Montani
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Etienne-Marie Jutant
- Pneumologie, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France
| | - Marion De Géa
- Department of Cardiology, CHU de Poitiers, Poitiers, France
| | - Damien Lanéelle
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Caen Normandie, Caen, France.,COMETE Laboratory, INSERM 1075, Université de Caen, 14000, Caen, France
| | - Cécile Thollot
- Vascular Medicine Unit, Cardio-Vascular Center, University Hospital of Poitiers, Poitiers, France
| | - Jean-Eudes Trihan
- Vascular Medicine Unit, Cardio-Vascular Center, University Hospital of Poitiers, Poitiers, France.
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4
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Deschamps J, Denault A, Galarza L, Rola P, Ledoux-Hutchinson L, Huard K, Gebhard CE, Calderone A, Canty D, Beaubien-Souligny W. Venous Doppler to Assess Congestion: A Comprehensive Review of Current Evidence and Nomenclature. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:3-17. [PMID: 36207224 DOI: 10.1016/j.ultrasmedbio.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/29/2022] [Accepted: 07/21/2022] [Indexed: 06/16/2023]
Abstract
Organ congestion from venous hypertension is an important pathophysiological mechanism mediating organ injury in several clinical contexts including critical illness, congestive heart failure and end-stage chronic kidney disease. However, the practical evaluation of venous congestion is often challenging at the bedside because of the limitations of traditional methods. Point-of-care ultrasound (POCUS) enables the clinician to assess venous velocity profiles during the cardiac cycle using Doppler modalities. Venous Doppler profile abnormalities at multiple sites are detected when elevated venous pressure results in hemodynamic changes within the systemic venous circulation. The detection of these abnormal Doppler profiles may identify patients with clinically significant systemic venous congestion. These patients have been reported to be at increased risk of medical complications. Improving the evaluation of venous congestion may lead to individualized treatment and improved patient outcomes. In this review, we describe the physiologic principles necessary to understand venous Doppler assessment. We also propose a nomenclature for the description of venous Doppler profiles. Finally, we provide a narrative review of the current clinical evidence related to use of venous Doppler assessment in various clinical contexts.
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Affiliation(s)
- Jean Deschamps
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - André Denault
- Department of Anesthesiology and Intensive Care, Montreal Heart Institute, Montréal, Canada
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Philippe Rola
- Division of Intensive Care, Hôpital Santa-Cabrini, Montréal, Canada
| | | | | | | | | | - David Canty
- Department of Surgery (Royal Melbourne Hospital), University of Melbourne, Parkville, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine and Nursing (Monash Medical Centre), Monash University, Clayton, Australia
| | - William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Innovation Hub, Centre de Recherche du CHUM, Montréal, Canada.
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Su E, Phan P, Riley A. Unexpected Vascular Ultrasound Findings Prompting Hemodynamic Management in an Infant in Respiratory Failure. CASE 2022; 6:247-249. [PMID: 36036047 PMCID: PMC9399627 DOI: 10.1016/j.case.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central venous pulsatility can reflect pulmonary hypertension. Rapid assessment of cardiac findings helps expedite hemodynamic management. Procedural point-of-care ultrasound may suggest critical diagnostic findings.
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6
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Silva VBC, Froes TR, Wolf M, Lucina SB, Sousa MG. Characterization of Doppler spectrum of hepatic veins in dogs with pulmonary hypertension. Res Vet Sci 2022; 150:131-136. [PMID: 35820267 DOI: 10.1016/j.rvsc.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/27/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
Abstract
Pulmonary hypertension (PH) triggers hemodynamic changes within the right heart, which may affect hepatic venous flow. The aims of this study were three-fold: to investigate, prospectively, the reliability of the hepatic vein Doppler waveform to diagnose and characterize the magnitude of PH in dogs; to evaluate whether a correlation exists between hepatic venous flow waves and the structural and functional characteristics of the right ventricle (RV); and to determine whether age, gender, body weight, heart rate (HR), heart rhythm and systolic blood pressure affect the hepatic venous waveform pattern. A cross-sectional observational study was carried out in 43 dogs with varying degrees of PH and a control group of 15 healthy dogs. The velocities of the hepatic A, S, V and D spectral waves and the phasic pattern varied according to the severity of PH. Weak to moderate correlations were documented between hepatic vein waves and age, HR, and the structural and functional variables of the RV. A D Wave cut-off of 11.6 cm ∙ s-1 had a sensitivity of 100% and specificity of 35% for differentiation of dogs with severe PH from healthy dogs. Doppler assessment of hepatic venous flow was shown to be a reliable technique for screening dogs for PH.
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Affiliation(s)
- V B C Silva
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná 80035-050, Brazil.
| | - T R Froes
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná 80035-050, Brazil
| | - M Wolf
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná 80035-050, Brazil
| | - S B Lucina
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná 80035-050, Brazil
| | - M G Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná 80035-050, Brazil
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Clinical utility of superior vena cava flow velocity waveform measured from the subcostal window for estimating right atrial pressure 1. J Am Soc Echocardiogr 2022; 35:727-737. [PMID: 35150833 DOI: 10.1016/j.echo.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Superior vena cava (SVC) flow velocity waveform from the supraclavicular window reflects the right atrial pressure (RAP) status. Recent guidelines have stated that the subcostal window is an alternative view for recording SVC flow, but the validity of this approach remains unclear. This study aimed to determine the usefulness of SVC flow evaluation from the subcostal window for estimating RAP. METHODS Differences in SVC flow characteristics between opposite approaches were examined in 38 healthy adults. In 115 patients with cardiovascular diseases who underwent cardiac catheterization and echocardiography within 48 h, the ratio of peak systolic to diastolic forward SVC flows was measured (SVC-S/D), and the diagnostic ability of SVC-S/D for elevated RAP was tested. A validation cohort was conducted to confirm the diagnostic ability of SVC-S/D in 48 patients who underwent both cardiac catheterization and echocardiography within 24 h. In 59 patients of derivation and validation cohorts, the relationship between SVC flow and RAP was compared between the opposite windows. RESULTS Both systolic and diastolic SVC flow velocities were higher in the subcostal than in the supraclavicular approach, and effect of position change on the subcostal SVC-S/D was smaller than that on the supraclavicular SVC-S/D in healthy adults. Measurement of SVC-S/D from the subcostal window was feasible in 98 patients (85%). RAP was inversely correlated with SVC-S/D (r=-0.50, P<.001), and was an independent determinant of SVC-S/D after the adjustment for right ventricular systolic function (β=-0.48, P<.001). A cutoff value of 1.9 for SVC-S/D showed 85% sensitivity and 74% specificity in identifying elevated RAP. Additionally, SVC-S/D showed an incremental diagnostic value combined with inferior vena cava size and collapsibility (P=.006). When the cutoff value, SVC-S/D<1.9, was applied to the validation cohort, it showed an acceptable accuracy of 72%, and an incremental diagnostic value combined with inferior vena cava parameters (P=.033). SVC-S/D from the subcostal window correlated better with RAP than that from the supraclavicular window (P<.001, Meng's test). CONCLUSIONS Measurement of SVC flow velocity from the subcostal window was feasible, and SVC-S/D from the subcostal window could be an additive parameter for estimating RAP.
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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Doppler Interrogation of the Femoral Vein in the Critically Ill Patient: The Fastest Potential Acoustic Window to Diagnose Right Ventricular Dysfunction? Crit Care Explor 2020; 2:e0209. [PMID: 33063023 PMCID: PMC7523763 DOI: 10.1097/cce.0000000000000209] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives To report the use of common femoral vein Doppler interrogation as a simple technique to diagnose right ventricular dysfunction. Design Case report. Setting Cardiac surgical ICU. Patients Postoperative cardiac surgical patients. Interventions Common femoral pulsed-wave and color Doppler examination associated with hepatic, portal, and renal venous Doppler measurement were obtained in both patients and before and after treatment in patient number 1. In addition, right ventricular pressure waveform examination was obtained in patient number 2. Measurements and Main Results The technique to obtain common femoral venous Doppler is described. Two cases of patients presenting with right ventricular dysfunction and fluid overload with portal and renal venous congestion in the perioperative period undergoing complex multivalvular cardiac surgery are presented. Hemodynamic waveform monitoring was performed alongside echocardiographic, hepatic, and renal venous flow Doppler assessment, and spectral Doppler profiles of the common femoral veins were examined. Those findings were useful in confirming our diagnosis and guiding our response to treatment. An algorithm was developed and tested on two additional hemodynamically unstable patients. Conclusions Doppler examination of the common femoral vein is a simple, fast, and noninvasive technique that could be useful to rule in the presence of right ventricular dysfunction with venous congestion and help guide the management of such patients.
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Acar E, Izci S, Inanir M, Yilmaz MF, Izgi IA, Gokce M, Kirma C. Hepatic venous Doppler assessment can anticipate simplified pulmonary embolism severity index and right ventricle dysfunction in patients with acute pulmonary embolism. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:254-262. [PMID: 32237150 DOI: 10.1002/jcu.22825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Acute pulmonary embolism (APE) is a life-threating cardiothoracic thromboembolic emergency in which right ventricle dysfunction (RVD) is a major concern. In the present study, we examined the hepatic veins (HVs) blood flow with pulsed-wave spectral Doppler ultrasonography to determine its relationship with the simplified pulmonary embolism severity index (sPESI) and the patient's RVD status. METHODS We divided the 243 patients who met the inclusion criteria into two groups based on both their sPESI scores and their RVD status. Transthoracic echocardiography was performed to evaluate the RVD and the HVs within 1 hour after patient admission. The liver was evaluated using subcostal and intercostal echocardiographic windows in grayscale B-mode, and HVs were assessed using color and spectral Doppler assessment though the same echocardiographic windows. RESULT A cut-off value of the systolic reverse flow velocity-time integral (SrVTI) = 2.2 cm carried a sensitivity and specificity of 84.29% and 74.89%, respectively, for the prediction of sPESI ≥ 1. A SrVTI cut-off value of 2.1 cm yielded a sensitivity and specificity of 83.03% and 73.91%, respectively, for the prediction of RVD. CONCLUSION HV Doppler assessment could be a useful method for anticipating the sPESI and the presence of RVD in patients with APE. In addition, it may provide information regarding the hemodynamic impact of APE.
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Affiliation(s)
- Emrah Acar
- Department of Cardiology, Gumushane State Hospital, Gumushane, Turkey
| | - Servet Izci
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Inanir
- Department of Cardiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet F Yilmaz
- Department of Cardiology, Siyami Ersek Research and Training Hospital, Istanbul, Turkey
| | - Ibrahim A Izgi
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Gokce
- Department of Cardiology, Medical Faculty of Karadeniz Technical University, Trabzon, Turkey
| | - Cevat Kirma
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
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Hemodynamic changes of the middle hepatic vein in patients with pulmonary hypertension using echocardiography. PLoS One 2015; 10:e0121408. [PMID: 25821961 PMCID: PMC4379104 DOI: 10.1371/journal.pone.0121408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/01/2015] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to analyze the changes of the middle hepatic vein (MHV) spectra in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD) and determine the proper parameters of MHV to predict PH. Eighty patients with CHD were included, whose pulmonary artery pressure was measured via right heart catheterization, and the MHV spectra were detected via echocardiography. The peak value of velocity (V) and velocity time integral (VTI) of the waves, including S wave, D wave and A wave, were measured at the end of inspiration. The values of the MHV parameters that were predictive of PH were evaluated and their cut-off points were determined. Compared with the control group, V of S wave (S), VTI of S wave (SVTI), V of D wave (D), VTI of D wave (DVTI) decreased and V of A wave (A), VTI of A wave (AVTI), A/S, AVTI/SVTI, A/(S+D), AVTI/ (SVTI+DVTI) increased in the PH group. These differences were statistically significant (P<0.05). A correlation analysis determined that the ratios of A/S, A/(S+D), AVTI/(SVTI+DVTI) were positively correlated with pulmonary artery mean pressure (r=0.529,0.575,0.438,P<0.001). An ROC curve analysis determined that the diagnostic effect of A/(S+D) was superior to the other two parameters. On the ROC curve, when the ratio of A/(S+D) was 0.30, the sensitivity was 85.37% and specificity was 75.00% for predicting PH. The spectral parameters of MHV, including the ratios of A/S, A/(S+D) and AVTI/(SVTI+DVTI), increased with increasing pulmonary pressure in CHD patients. When the ratio of A/(S+D) was 0.30 in MHV spectra, it had sufficient sensitivity and specificity for diagnosing PH, and this method could be used as a new non-invasive complementary echocardiographic parameter for predicting PH.
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Fadel BM, Alkalbani A, Husain A, Dahdouh Z, Di Salvo G. Respiratory hemodynamics in the hepatic veins-normal pattern. Echocardiography 2014; 32:585-8. [PMID: 25220604 DOI: 10.1111/echo.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Doppler interrogation of blood flow in the hepatic veins (HVs) is a part of any comprehensive echocardiographic examination. Data derived from the HV Doppler provide a useful tool for the assessment of right heart function. Beyond its dependence on the cardiac cycle, right heart hemodynamics, and compliance of the liver parenchyma, blood flow in the HVs is influenced by the respiratory cycle. Systematic analysis of the behavior of the HV Doppler during respiration allows one to recognize normal and abnormal flow-patterns and distinguish among various disease states that involve the right heart. In this manuscript we discuss the effect of respiration on the HV Doppler in individuals with normal right heart function.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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