Preferential Streaming of the Ductus Venosus Toward the Right Atrium Is Associated With a Worse Outcome Despite a Higher Rate of Invasive Procedures in Human Fetuses With Left Diaphragmatic Hernia

2013 ◽  
Vol 34 (06) ◽  
pp. 568-572 ◽  
Author(s):  
R. Stressig ◽  
R. Fimmers ◽  
T. Schaible ◽  
J. Degenhardt ◽  
R. Axt-Fliedner ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Right Atrium ◽  
Ductus Venosus ◽  
Human Fetuses ◽  
Invasive Procedures ◽  
The Right

Preferential Ductus Venosus Streaming Toward the Right Heart Is Associated with Left Heart Underdevelopment and Aortic Arch Hypoplasia in Human Fetuses

2011 ◽  
Vol 32 (S 02) ◽  
pp. E115-E121
Author(s):  
R. Stressig ◽  
R. Axt-Fliedner ◽  
U. Gembruch ◽  
T. Kohl
Keyword(s):  
Aortic Arch ◽  
Diaphragmatic Hernia ◽  
Pulmonary Vein Stenosis ◽  
Ductus Venosus ◽  
Human Fetuses ◽  
Left Heart ◽  
Caval Vein ◽  
Age Related ◽  
The Right ◽  
Aortic Arch Hypoplasia

Abstract Purpose: Preferential left heart underdevelopment in human fetuses with diaphragmatic hernia is almost uniformly associated with preferential streaming of the ductus venosus toward the right side of the heart. The purpose of our study was to examine whether this flow anomaly might also be present in other fetuses with hypoplasia of left-sided cardiovascular structures. Materials and Methods: We studied 32 fetuses with left heart hypoplasia as defined by gestational age-related Z-scores by echocardiography. Apart from defining cardiovascular morphology as detailed as possible, particular focus was put on the presence or absence of preferential streaming of the ductus venosus and inferior caval vein toward the right side of the heart. Results: 8 of 32 fetuses with hypoplasia of one or more left-sided cardiovascular structures exhibited preferential streaming of the ductus venosus toward the right side of the heart. In all eight fetuses, this finding was associated with additional cardiovascular anomalies like aortic valve stenosis, ventricular septal defect, left superior caval vein-to-coronary sinus, pulmonary vein stenosis and/or aortic arch hypoplasia. Conclusion: As in human fetuses with left diaphragmatic hernia, preferential ductus venosus streaming toward the right side of the heart can be found in a subgroup of fetuses with hypoplasia of left-sided cardiovascular structures.

scholarly journals Effect of breathing on venous return during delayed cord clamping: an observational study

2021 ◽  
pp. fetalneonatal-2020-321431
Author(s):  
Emma Brouwer ◽  
Ronny Knol ◽  
Annie Kroushev ◽  
Thomas Van Den Akker ◽  
Stuart B Hooper ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Right Atrium ◽  
Spontaneous Breathing ◽  
Venous Return ◽  
Vena Cava ◽  
Ductus Venosus ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Digital Format ◽  
The Right

ObjectiveTo investigate the effect of spontaneous breathing on venous return in term infants during delayed cord clamping at birth.MethodsEchocardiographic ultrasound recordings were obtained directly after birth in healthy term-born infants. A subcostal view was used to obtain an optimal view of the inferior vena cava (IVC) entering the right atrium, including both the ductus venosus (DV) and the hepatic vein (HV). Colour Doppler was used to assess flow direction and flow velocity. Recordings continued until the umbilical cord was clamped and were stored in digital format for offline analyses.ResultsUltrasound recordings were obtained in 15 infants, with a median (IQR) gestational age of 39.6 (39.0–40.9) weeks and a birth weight of 3560 (3195–4205) g. Flow was observed to be antegrade in the DV and HV in 98% and 82% of inspirations, respectively, with flow velocity increasing in 74% of inspirations. Retrograde flow in the DV was observed sporadically and only occurred during expiration. Collapse of the IVC occurred during 58% of inspirations and all occurred caudal to the DV inlet (100%).ConclusionSpontaneous breathing was associated with collapse of the IVC and increased antegrade DV and HV flow velocity during inspiration. Therefore, inspiration appears to preferentially direct blood flow from the DV into the right atrium. This indicates that inspiration could be a factor driving placental transfusion in infants.

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