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.

scholarly journals Effect of spontaneous breathing on umbilical venous blood flow and placental transfusion during delayed cord clamping in preterm lambs

2019 ◽  
Vol 105 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Emma Brouwer ◽  
Arjan B te Pas ◽  
Graeme R Polglase ◽  
Erin V McGillick ◽  
Stefan Böhringer ◽  
...  
Keyword(s):  
Blood Flow ◽  
Body Weight ◽  
Spontaneous Breathing ◽  
Venous Blood ◽  
Vena Cava ◽  
Venous Blood Flow ◽  
Delayed Cord Clamping ◽  
Venous Flow ◽  
Cord Clamping ◽  
Pregnant Sheep

IntroductionDuring delayed umbilical cord clamping, the factors underpinning placental transfusion remain unknown. We hypothesised that reductions in thoracic pressure during inspiration would enhance placental transfusion in spontaneously breathing preterm lambs.ObjectiveInvestigate the effect of spontaneous breathing on umbilical venous flow and body weight in preterm lambs.MethodsPregnant sheep were instrumented at 132–133 days gestational age to measure fetal common umbilical venous, pulmonary and cerebral blood flows as well as arterial and intrapleural (IP) pressures. At delivery, doxapram and caffeine were administered to promote breathing. Lamb body weights were measured continuously and breathing was assessed by IP pressure changes.ResultsIn 6 lambs, 491 out of 1117 breaths were analysed for change in body weight. Weight increased in 46.6% and decreased in 47.5% of breaths. An overall mean increase of 0.02±2.5 g per breath was calculated, and no net placental transfusion was observed prior to cord clamping (median difference in body weight 52.3 [−54.9–166.1] g, p=0.418). Umbilical venous (UV) flow transiently decreased with each inspiration, and in some cases ceased, before UV flow normalised during expiration. The reduction in UV flow was positively correlated with the standardised reduction in (IP) pressure, increasing by 109 mL/min for every SD reduction in IP pressure. Thus, the reduction in UV flow was closely related to inspiratory depth.ConclusionsSpontaneous breathing had no net effect on body weight in preterm lambs at birth. UV blood flow decreased as inspiratory effort increased, possibly due to constriction of the inferior vena cava caused by diaphragmatic contraction, as previously observed in human fetuses.

scholarly journals Right Upper Lobe Partial Anomalous Pulmonary Venous Connection

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Christos Tourmousoglou ◽  
Christina Kalogeropoulou ◽  
Efstratios Koletsis ◽  
Nikolaos Charoulis ◽  
Christos Prokakis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Right Atrium ◽  
Venous Return ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Systemic Vein ◽  
Anomalous Pulmonary Venous Return ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

Partial anomalous pulmonary venous return (PAPVR) is a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. We report a case of a 45-year-old male with PAPVR to superior vena cava which was incidentally discovered during a right lower bilobectomy for lung cancer.

scholarly journals Congenital systemic venous return anomalies to the right atrium review

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
João Diogo Oliveira ◽  
Isa Martins
Keyword(s):  
Right Atrium ◽  
Congenital Anomalies ◽  
Venous Return ◽  
Congenital Abnormalities ◽  
Venous Blood ◽  
Vena Cava ◽  
The Body ◽  
Venae Cavae ◽  
Systemic Venous Return ◽  
The Right

AbstractCongenital anomalies of the systemic venous return to the right atrium are rare and stem from variations in the embryogenesis of the venous system. They are usually asymptomatic, and such the major clinical significance of their recognition is to prevent misdiagnosis, in addition to some having technical implications on invasive procedures.Typically, the venous blood from the upper half of the body is carried by the right-sided, superior vena cava (SVC), and some common congenital abnormalities found are persistent left SVC, SVC duplication, anomalous drainage of the brachiocephalic veins, or interruption of the SVC. The venous blood from the lower body is carried by the right-sided, inferior vena cava (IVC), and some common congenital abnormalities found are left-sided IVC, IVC duplication, the absence of IVC (total or just the infrarenal segment), and azygos continuation of the IVC. The azygos system of veins, running up the side of the thoracic vertebral column, connects both systems and can provide an alternative path to the right atrium when either of the venae cavae is absent. Other associated azygos-hemiazygos system anomalies are the azygos lobe and variable configuration of the azygos and hemiazygos veins.Such anomalies are reviewed with particular respect to their embryology and imagiological presentation, as knowledge of the normal anatomy and the most common congenital anomalies of the systemic venous return by a radiologist is important, being incidentally found.

Central venous pressure monitoring in critical care settings

2021 ◽  
Vol 30 (4) ◽  
pp. 230-236
Author(s):  
Barry Hill ◽  
Catherine Smith
Keyword(s):  
Critical Care ◽  
Central Venous Pressure ◽  
Right Atrium ◽  
Venous Pressure ◽  
Vena Cava ◽  
Alternative Methods ◽  
Haemodynamic Monitoring ◽  
Haemodynamic Instability ◽  
Central Venous ◽  
The Right

Patients who present with acute cardiovascular compromise require haemodynamic monitoring in a critical care unit. Central venous pressure (CVP) is the most frequently used measure to guide fluid resuscitation in critically ill patients. It is most often done via a central venous catheter (CVC) positioned in the right atrium or superior or inferior vena cava as close to the right atrium as possible. The CVC is inserted via the internal jugular vein, subclavian vein or via the femoral vein, depending on the patient and their condition. Complications of CVC placement can be serious, so its risks and benefits need to be considered. Alternative methods to CVC use include transpulmonary thermodilution and transoesophageal Doppler ultrasound. Despite its widespread use, CVP has been challenged in many studies, which have reported it to be a poor predictor of haemodynamic responsiveness. However, it is argued that CVP monitoring provides important physiologic information for the evaluation of haemodynamic instability. Nurses have central roles during catheter insertion and in CVP monitoring, as well as in managing these patients and assessing risks.

scholarly journals P649 Before and after: sinus venosus atrial septal defect

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Marco Clement ◽  
R Eiros ◽  
R Dalmau ◽  
T Lopez ◽  
G Guzman ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Septal Defect ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

ANOMALIES OF THE PULMONARY VEINS AND THEIR SURGICAL SIGNIFICANCE

PEDIATRICS ◽  
1952 ◽  
Vol 9 (2) ◽  
pp. 152-166
Author(s):  
HARRY G. PARSONS ◽  
ANN PURDY ◽  
BRUCE JESSUP
Keyword(s):  
Superior Vena Cava ◽  
Clinical Symptoms ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Ductus Venosus ◽  
Return Flow ◽  
Right Heart ◽  
Surgical Measures ◽  
The Right

The successful operations upon abnormalities of the outflow tracts of the heart suggest that surgical measures may also be applied to the correction of abnormal inflow tracts. Technically the anastomosis of veins to the auricle has been proved feasible in the experimental animal. Therefore, it should be possible to correct abnormally placed pulmonary veins in man. A wide variety of such anomalies occur. In 55 of 136 reported cases, all the oxygenated blood from the lungs was returned to the right heart through anomalous vessels. Thirty-five per cent of these cases of complete diversion were accompanied by other major cardiac defects. It is estimated that 50% or more of the return flow from the lungs must reach the right heart to produce clinical symptoms. Two cases are presented of persistence of the left superior vena cava which transmitted all the freshly oxygenated blood to the right auricle, by way of the left innominate and the right superior vena cava. The clinical picture was that of growth retardation, minimal cyanosis, a huge hyperactive heart, a loud left mesocardial systolic murmur, pulsating shadows in both upper pulmonary fields, and nearly identical oxygen-saturation of blood obtained from the right heart and femoral artery. One case is reported in which all the oxygenated blood from the lungs is carried to the right auricle by way of the ductus venosus. Surgical correction of the abnormality of these cases by transplantation of one or more of the veins would have been possible. However, no case known to the authors has yet been successfully corrected.

TYPES OF CORRECTION OF THE SUPRACARDIAC FORM OF PARTIAL ABNORMAL DRAINAGE OF THE PULMONARY VEINS. WARDEN PROCEDURE

2021 ◽  
pp. 28-31
Author(s):  
Inkar Sagatov ◽  
Nurzhan Dosmailov
Keyword(s):  
Left Atrium ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Artificial Circulation ◽  
The Right

The article describes the types of correction of the supracardial form of abnormal drainage of the pulmonary veins. One of the methods of correcting this defect is the Warden operation, which includes: after sternotomy, connection of artificial circulation, cardioplegia, the superior vena cava is cut off, the proximal end is sutured. Next, a right atriotomy is performed, an anastomosis is formed using an autopericardial patch between the abnormal drainage and the left atrium through the ASD. Then an anastomosis is formed between the auricle of the right atrium and the distal end of the superior vena cava. As a result, blood from the abnormal pulmonary veins begins to drain into the left atrium through the ASD.

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