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RoFo : Fortschritte Auf Dem Gebiete Der... May 2021the ductus venosus (DV) is not well known in general radiology, but it plays a role in the daily work of pediatric radiologists. Consequently all general radiologists... (Review)
Review
BACKGROUND
the ductus venosus (DV) is not well known in general radiology, but it plays a role in the daily work of pediatric radiologists. Consequently all general radiologists who also care for a pediatric department should be familiar with the physiological and pathological findings related to the DV.
METHODS
Literature research in Medline, using the keywords "ductus venosus" and "umbilical vein catheter".
RESULTS AND CONCLUSIONS
In the first weeks of life the DV is regularly still patent. It should be recognized as DV and not be mistaken for a pathological portosystemic shunt.The ductus venosus is the lead structure for umbilical vein catheters. Radiologists should be able to assess the correct catheter position. Radiologically important findings of an umbilical vein catheter are mainly malposition and intrahepatic extravasation. Agenesis of the DV can lead to intra- or extrahepatic compensatory portosystemic shunts, in which as well as in the case of persistent patency of the DV, there may be the necessity for radiological-interventional or surgical occlusion.
KEY POINTS
· In the first weeks of life in infants the Ductus venosus is regularly still patent.. · The Ductus venosus should not be mistaken for a pathological portosystemic shunt.. · An umbilcal vein catheter should project onto the Ductus venosus and end caudal to the right atrium.. · Intrahepatic portosystemic shunts in DV agenesis show a high rate of spontaneous closure postnatally..
CITATION FORMAT
· Born M. The Ductus Venosus. Fortschr Röntgenstr 2021; 193: 521 - 526.
Topics: Humans; Infant, Newborn; Umbilical Veins; Vascular Diseases
PubMed: 33152783
DOI: 10.1055/a-1275-0984 -
Journal of Clinical Ultrasound : JCU Feb 2023Placental blood supply to the fetus can be measured by evaluating the umbilical vein blood flow. Despite its potential application in healthcare, the umbilical vein... (Review)
Review
Placental blood supply to the fetus can be measured by evaluating the umbilical vein blood flow. Despite its potential application in healthcare, the umbilical vein blood flow volume is still used only in research setting. One of the reasons is a concern regarding its reproducibility, partly due to technology issues. Nowadays, technology improvements make this evaluation accurate and reproducible. The aim of this review is to refresh basic elements of the physiology of umbilical vein blood flow and its analysis. Its evaluation in normal and abnormal fetal growth is also discussed.
Topics: Pregnancy; Female; Humans; Umbilical Veins; Placenta; Reproducibility of Results; Ultrasonography, Doppler; Hemodynamics; Fetus; Blood Flow Velocity; Umbilical Arteries; Ultrasonography, Prenatal; Fetal Growth Retardation
PubMed: 36785504
DOI: 10.1002/jcu.23412 -
Ultrasound in Obstetrics & Gynecology :... May 2018To investigate the ultrasound characteristics and outcome of pregnancies with fetal intra-abdominal umbilical vein varix (FIUVV). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the ultrasound characteristics and outcome of pregnancies with fetal intra-abdominal umbilical vein varix (FIUVV).
METHODS
Cases of FIUVV managed at our tertiary university hospital over an 8-year period were reviewed. Information retrieved included gestational age and diameter of the umbilical varix at diagnosis, increase in varix diameter, associated ultrasound or chromosomal anomalies and pregnancy outcome. Furthermore, a systematic review and meta-analysis of series of FIUVV in the literature was performed to assess the incidence of chromosomal anomalies, small-for-gestational age infants and intrauterine fetal demise (IUFD), and to pool odds ratio (OR) estimates on the relationship between the incidence of these outcomes and the presence of additional associated ultrasound anomalies.
RESULTS
Thirteen cases of FIUVV were included in the cohort study. Additional ultrasound anomalies were found in two (15.4%) of 13 cases. One case of IUFD was observed and no case of chromosomal anomaly or thrombosis of varix was recorded. A total of five studies comprising 254 cases met the inclusion criteria of the systematic review. FIUVV was associated with additional ultrasound anomalies (non-isolated FIUVV) in 19% (95% CI, 10.9-29.1%) of cases. No case of chromosomal abnormality or IUFD was reported in fetuses with isolated FIUVV. In contrast, in the group of non-isolated FIUVV, the incidence of chromosomal anomalies was 19.6% and that of IUFD was 7.3%, with ORs of 14.8 (95% CI, 2.9-73.0) and 8.2 (95% CI, 1.05-63.1), respectively, when compared with the group of isolated FIUVV.
CONCLUSION
When isolated, the outcome of cases affected by FIUVV is usually favorable. In about 20% of cases, additional ultrasound anomalies are found, which are associated with an increased risk for chromosomal abnormalities and IUFD. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Female; Fetal Diseases; Fetus; Gestational Age; Humans; Pregnancy; Retrospective Studies; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Veins; Varicose Veins
PubMed: 28876490
DOI: 10.1002/uog.18895 -
Diagnostic and Interventional Imaging Jan 2015Foetal intra-abdominal umbilical vein varix is rare. Colour Doppler ultrasonography helps distinguish this vascular anomaly. A detailed anatomic scan must be performed... (Review)
Review
Foetal intra-abdominal umbilical vein varix is rare. Colour Doppler ultrasonography helps distinguish this vascular anomaly. A detailed anatomic scan must be performed to exclude associated anomalies: forms associated with additional complications are found in 29 to 35% of the cases. Intra-uterine foetal demise (IUFD) is a complication of umbilical vein varix. However, recent studies are more reassuring. When foetal intra-abdominal umbilical vein varix is isolated, there is no reason to change the management of the pregnancy. Foetal sonographic follow-up is recommended, focusing on an increase in the size of the varix and the appearance of a clot. A particular clinical form, connecting the umbilicus to the extra-hepatic portal vein should be known, because of a high risk of thrombosis. On the basis of this finding, postnatal monitoring by ultrasound is necessary.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Ultrasonography, Prenatal; Umbilical Veins; Varicose Veins
PubMed: 24631035
DOI: 10.1016/j.diii.2014.01.009 -
BMC Pregnancy and Childbirth Apr 2021Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF... (Review)
Review
BACKGROUND
Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF is characterized by yellow-white bands running parallel to the umbilical blood vessels. These bands consist of inflammatory cells, necrotic debris, and calcium deposits. Calcification is visible in ultrasonography, which makes it possible to suspect NF when umbilical vascular wall calcification is detected by prenatal ultrasonography.
CASE PRESENTATION
Ultrasonography revealed calcification of the umbilical venous wall in an expectant 31-year-old woman who was gravida 1, para 0. The woman required emergency cesarean section because of fetal distress and suspected umbilical cord torsion at 31 weeks gestation. The root of the umbilical cord was quite fragile and broke during the operation. The pathological results on the placenta showed histologic chorioamnionitis and NF. The infant was diagnosed to have neonatal sepsis and acidosis after delivery but was discharged without severe complications after a one-month hospitalization that included antibiotic and supportive therapy.
CONCLUSION
NF is a rare and severe inflammation of the umbilical cord. Umbilical vascular wall calcification discovered in prenatal ultrasonography is diagnostically helpful.
Topics: Adult; Cesarean Section; Chorioamnionitis; Female; Humans; Imaging, Three-Dimensional; Infant, Newborn; Infant, Very Low Birth Weight; Male; Necrosis; Pregnancy; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Cord; Umbilical Veins; Vascular Calcification
PubMed: 33845786
DOI: 10.1186/s12884-021-03743-3 -
Journal of Medicine and Life Aug 2023Scientific research in the field of physiology and pathology of the umbilical cord is quite limited and imperfect. The purpose of the study was to evaluate the...
Scientific research in the field of physiology and pathology of the umbilical cord is quite limited and imperfect. The purpose of the study was to evaluate the histological architecture of the pathological umbilical cord and investigate the relationship between the main parameters and placental postnatal macromorphometric characteristics, which serve as a reflection of placental dysfunction. Four groups of patients were included, each undergoing a postnatal histological and topographic examination of the umbilical cord: Wharton's jelly edema (10 samples), velamentous cord insertion (10 samples), single umbilical artery (10 samples), and physiological pregnancy (10 samples). Compared to the control group, all newborn groups exhibited changes in umbilical vessel morphology, characterized by an increased Wagenworth index and a decreased Kernohan index. The functional indices of the umbilical vessels were found to be most severely affected in cases of Wharton's jelly edema. In cases of single umbilical artery, the changes in vascular functional parameters indicated their compensatory remodeling with the highest Wagenworth and Kernohan indices of the umbilical vein. Deviation from the normal average placental weight was observed in cases of Wharton's jelly volume pathology or velamentous cord insertion. However, in the case of a single umbilical artery, there were no significant deviations in the macromorphometry of the placenta.
Topics: Infant, Newborn; Humans; Pregnancy; Female; Single Umbilical Artery; Placenta; Umbilical Cord; Umbilical Veins; Edema
PubMed: 38024812
DOI: 10.25122/jml-2023-0025 -
The Annals of Thoracic Surgery Jun 2018Synthetic graft materials are commonly used for shunts and cardiovascular reconstruction in neonates, but are prone to thrombosis and scarring. The umbilical vein is a...
BACKGROUND
Synthetic graft materials are commonly used for shunts and cardiovascular reconstruction in neonates, but are prone to thrombosis and scarring. The umbilical vein is a potential source of autologous, endothelialized tissue for neonatal shunts and tissue reconstruction, but requires preservation before implantation.
METHODS
Umbilical cords were collected in UW solution with antibiotics at 4°C until dissection. Umbilical vein segments were tested for burst pressure before and after 2 weeks of preservation. Umbilical veins segments were preserved under static or flow conditions at 4°C in UW solution with 5% human plasma lysate for 7 days. Veins were evaluated with histopathology, scanning electron microscopy, and platelet adhesion testing.
RESULTS
Umbilical veins have no difference in burst pressure at harvest (n = 16) compared with 2 weeks of preservation (n = 11; 431 ± 229 versus 438 ± 244 mm Hg). After 1 week, static and flow-preserved veins showed viability of the vessel segments with endothelium staining positive for CD31, von Willebrand factor, and endothelial nitric oxide synthase. Scanning electron microscopy demonstrated preservation of normal endothelial morphology and flow alignment in the flow-preserved samples compared with cobblestone endothelial appearance and some endothelial cell loss in the static samples. Static samples had significantly more platelet adhesion than flow-preserved samples did.
CONCLUSIONS
Umbilical veins have adequate burst strength to function at neonatal systemic pressures. Preservation under flow conditions demonstrated normal endothelial and overall vascular morphology with less platelet adhesion compared with static samples. Preserved autologous umbilical veins are potential source for endothelialized shunts or cardiovascular repair tissue for neonates.
Topics: Biopsy, Needle; Cardiac Surgical Procedures; Endothelium, Vascular; Female; Humans; Immunohistochemistry; Infant, Newborn; Male; Microscopy, Electron, Scanning; Organ Preservation Solutions; Plastic Surgery Procedures; Sensitivity and Specificity; Tissue Preservation; Tissue and Organ Harvesting; Transplantation, Autologous; Umbilical Veins
PubMed: 29510094
DOI: 10.1016/j.athoracsur.2018.01.076 -
Clinical Epigenetics May 2019Hypertension is one of primary clinical presentations of pre-eclampsia. The occurrence and progress of hypertension are closely related to vascular dysfunction. However,...
BACKGROUND
Hypertension is one of primary clinical presentations of pre-eclampsia. The occurrence and progress of hypertension are closely related to vascular dysfunction. However, information is limited regarding the pathological changes of vascular functions in pre-eclamptic fetuses. Human umbilical cord vein was used to investigate the influence of pre-eclampsia on fetal blood vessels in this study.
RESULTS
The present study found that the vasoconstriction responses to arginine vasopressin (AVP) and oxytocin (OXT) were attenuated in the pre-eclamptic umbilical vein as compared to in normal pregnancy, which was related to the downregulated AVP receptor 1a (AVPR1a), OXT receptor (OXTR), and protein kinase C isoform β (PKCβ), owing to the deactivated gene transcription, respectively. The deactivated AVPR1a, OXTR, and PKCB gene transcription were respectively linked with an increased DNA methylation within the gene promoter.
CONCLUSIONS
To the best of our knowledge, this study first revealed that a hyper-methylation in gene promoter, leading to relatively reduced patterns of AVPR1a, OXTR, and PKCB expressions, which was responsible for the decreased sensitivity to AVP and OXT in the umbilical vein under conditions of pre-eclampsia. The data offered new and important information for further understanding the pathological features caused by pre-eclampsia in the fetal vascular system, as well as roles of epigenetic-mediated gene expression in umbilical vascular dysfunction.
Topics: Adult; Arginine Vasopressin; Case-Control Studies; DNA Methylation; Down-Regulation; Epigenesis, Genetic; Female; Humans; Oxytocin; Pre-Eclampsia; Pregnancy; Promoter Regions, Genetic; Protein Kinase C beta; Receptors, Oxytocin; Receptors, Vasopressin; Umbilical Veins; Young Adult
PubMed: 31138298
DOI: 10.1186/s13148-019-0685-2 -
Journal of Ultrasound in Medicine :... Oct 2022Placental blood flow analysis is complicated by having both maternal and fetal flow components. Using the Fast Fourier Transform (FFT) of the umbilical venous pulse wave...
OBJECTIVES
Placental blood flow analysis is complicated by having both maternal and fetal flow components. Using the Fast Fourier Transform (FFT) of the umbilical venous pulse wave spectra (PW) envelope, we could simultaneously assess maternal/fetal blood flow in the placenta and investigate if normal and intrauterine growth restriction (IUGR)/pre-eclamptic pregnancies could be distinguished.
METHODS
This retrospective study included normal gestations (N = 11) and gestations with IUGR, pre-eclampsia, or both (N = 13). Umbilical vein PW were acquired and spectral envelopes were identified as a function of time and analyzed by FFT. Base-10 logarithms of the ratios of the maternal/fetal spectral peaks (LRSP) were compared in normal and IUGR/pre-eclamptic populations (two-tailed t-test). Body mass index (BMI), gestational age at scan time, placental position, and weight-normalized umbilical vein blood volume flow (two-tailed t-test, analysis of variance [ANOVA] analysis) were tested. P < .05 was considered significant.
RESULTS
The LRSP for normal and IUGR/pre-eclamptic pregnancies were 0.141 ± 0.180 and -0.072 ± 0.262 (mean ± standard deviation), respectively (P = .033). We detected differences between normal gestations and combinations of LRSP and weight-normalized umbilical venous blood flows. Placental effects based on LRSPs and blood flow may act synergistically in cases with both pre-eclampsia and IUGR (P = .014). No other significant associations were seen.
CONCLUSIONS
In this preliminary study, we showed that umbilical venous flow contains markers related to placental maternal/fetal blood flow, which can be used to assess IUGR and pre-eclampsia. When coupled with umbilical cord blood flow, this new marker may potentially identify the primary causes of the two conditions.
Topics: Female; Fetal Growth Retardation; Humans; Placenta; Pre-Eclampsia; Pregnancy; Retrospective Studies; Umbilical Arteries; Umbilical Veins
PubMed: 34935157
DOI: 10.1002/jum.15927 -
BMC Pregnancy and Childbirth Oct 2020Persistent right umbilical vein (PRUV) is characterized by atresia of the left umbilical vein while the right umbilical vein remains open. Given the limited sample size...
BACKGROUND
Persistent right umbilical vein (PRUV) is characterized by atresia of the left umbilical vein while the right umbilical vein remains open. Given the limited sample size of most studies, the incidence of PRUV and the status of concomitant anomalies may not be fully reflected. Thus, we studied the incidence of fetal PRUV and its concomitant anomalies on a larger scale using our hospital database. This study hoped to address the following questions: Does PRUV increase the risk of fetal anomalies? If the PRUV fetus also has a single umbilical artery (SUA), does the risk of fetal anomaly increase further? What is the positive predictive value of PRUV for fetal anomalies?
METHODS
This retrospective study analyzed 756 cases of fetal PRUV at our hospital from January 2007 to April 2017. Prenatal ultrasound and color Doppler images were assessed. All PRUV fetuses underwent echocardiography and detailed ultrasound examinations of other systems. Newborn status was obtained via the database or by telephone follow-up.
RESULTS
A total of 435,428 pregnant women underwent prenatal ultrasonography at 16-40 weeks, the incidence of fetal PRUV was 0.17%, and 102 fetuses (13.5%) developed other anomalies. Two complicated cases had trisomy 18. PRUV was associated with a higher incidence of fetal anomalies. When fetal anomalies were classified by body systems, PRUV was associated with a higher incidence of cardiovascular, nervous, urinary, skeletal, digestive, and respiratory system anomalies. The positive predictive values of a PRUV for any fetal anomalies and cardiovascular anomalies were 13.5% (95%CI, 11.2-16.2%) and 5.4% (95%CI, 4.0-7.3%), respectively. SUA further increases the risk of PRUV fetuses with other anomalies and cardiovascular anomalies.
CONCLUSIONS
Detailed prenatal ultrasonography and echocardiography should be performed in fetuses with PRUV to rule out anomalies in other systems. When the PRUV is combined with SUA, echocardiography is particularly important. Fetuses with complicated PRUV should undergo chromosomal examination. Although isolated fetal PRUV prognosis is good, complicated PRUV prognosis depends on the type and severity of the concomitant anomalies.
Topics: Adult; Cardiovascular Abnormalities; Echocardiography; Female; Fetus; Humans; Incidence; Infant, Newborn; Predictive Value of Tests; Pregnancy; Retrospective Studies; Risk Assessment; Risk Factors; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Veins; Young Adult
PubMed: 33036561
DOI: 10.1186/s12884-020-03310-2