The fetal venous system, Part I: Normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation

Ultrasound in Obstetrics and Gynecology

Volumn 35, Issue 6, 2010, Pages 741-750

  Yagel, S ^a   Kivilevitch, Z ^b   Cohen, S M ^a   Valsky, D V ^a   Messing, B ^a   Shen, O ^a   Achiron, R ^c  

^a HEBREW UNIVERSITY OF JERUSALEM   (Israel)

^b MACCABI HEALTHCARE SERVICES   (Israel)

^c SHEBA MEDICAL CENTER   (Israel)

Author keywords

3D 4D ultrasound; Doppler; Fetal anatomy; Fetal physiology; Fetal venous system; Venous embryology

Indexed keywords

CARDIOVASCULAR FUNCTION; CARDIOVASCULAR SYSTEM; COLOR ULTRASOUND FLOWMETRY; ECHOGRAPHY; FETUS; HEMODYNAMICS; HISTOLOGY; HUMAN; METHODOLOGY; PHYSIOLOGY; REVIEW; VASCULARIZATION;

CARDIOVASCULAR PHYSIOLOGICAL PHENOMENA; CARDIOVASCULAR SYSTEM; FETUS; HEMODYNAMICS; HUMANS; ULTRASONOGRAPHY, DOPPLER, COLOR;

EID: 77953557612     PISSN: 09607692     EISSN: 14690705     Source Type: Journal    
DOI: 10.1002/uog.7618     Document Type: Article

References (61)

1. th edn). Williams & Wilkins: Philadelphia, PA, 1985.
2. th edn). WB Saunders: Philadelphia, PA, 1998.
3. Larsen WJ. Essentials of Human Embryology. Churchill Livingstone: London, UK, 1998.
4. Mavrides E, Moscoso G, Carvalho JS, Campbell S, Thilaganathan B. The anatomy of the umbilical, portal and hepatic venous systems in the human fetus at 14-19 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18: 598-604.
5. Collardeau-Frachon S, Scoazec JY. Vascular development and differentiation during human liver organogenesis. Anat Rec (Hoboken) 2008; 291: 614-627.
6. Huisman TW, Gittenberger-de Groot AC, Wladimiroff JW. Recognition of a fetal subdiaphragmatic venous vestibulum essential for fetal venous Doppler assessment. Pediatr Res 1992; 32: 338-341.
7. Pearson AA, Sauter RW. Observations on the phrenic nerves and the ductus venosus in human embryos and fetuses. Am J Obstet Gynecol 1971; 110: 560-565.
8. Mavrides E, Moscoso G, Carvalho JS, Campbell S, Thilaganathan B. The human ductus venosus between 13 and 17 weeks of gestation: histological and morphometric studies. Ultrasound Obstet Gynecol 2002; 19: 39-46.
9. Czubalski A, Aleksandrowicz R. Connection types between portal vein and portal sinus during foetal life. Folia Morphol (Warsz) 2000; 59: 97-98.
10. Kivilevitch Z, Gindes L, Deutsch H, Achiron R. In-utero evaluation of the fetal umbilical-portal venous system: two- and three-dimensional ultrasonic study. Ultrasound Obstet Gynecol 2009; 34: 634-642.
11. Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR. Ultrasono-graphic velocimetry of the fetal ductus venosus. Lancet 1991; 338: 1412-1414.
12. Huisman TW, van den Eijnde SM, Stewart PA, Wladimiroff JW. Changes in inferior vena cava blood flow velocity and diameter during breathing movements in the human fetus. Ultrasound Obstet Gynecol 1993; 3: 26-30.
13. Chiba Y, Utsu M, Kanzaki T, Hasegawa T. Changes in venous flow and intra tracheal flow in fetal breathing movements. Ultrasound Med Biol 1985; 11: 43-49.
14. Indik JH, Reed KL. Variation and correlation in human fetal umbilical Doppler velocities with fetal breathing: evidence of the cardiac-placental connection. Am J Obstet Gynecol 1990; 163: 1792-1796.
15. Brace RA. Regulation of blood volume in utero. In Fetus and Neonate. Physiology and Clinical Applications, Hanson MA, Spencer JAD, Rodeck CH (eds). Cambridge University Press: Cambridge, UK, 1993; 75-99.
16. Kiserud T, Acharya G. The fetal circulation. Prenat Diagn 2004; 24: 1049-1059.
17. Kiserud T, Ebbing C, Kessler J, Rasmussen S. Fetal cardiac output, distribution to the placenta and impact of placental compromise. Ultrasound Obstet Gynecol 2006; 28: 126-136.
18. Sutton MG, Plappert T, Doubilet P. Relationship between placental blood flow and combined ventricular output with gestational age in normal human fetus. Cardiovasc Res 1991; 25: 603-608.
19. Kiserud T, Rasmussen S, Skulstad S. Blood flow and the degree of shunting through the ductus venosus in the human fetus. Am J Obstet Gynecol 2000; 182: 147-153.
20. Boito S, Struijk PC, Ursem NT, Stijnen T, Wladimiroff JW. Umbilical venous volume flow in the normally developing and growth-restricted human fetus. Ultrasound Obstet Gynecol 2002; 19: 344-349.
21. Edelstone DI, Rudolph AM, Heymann MA. Liver and ductus venosus blood flows in fetal lambs in utero. Circ Res 1978; 42: 426-433.
22. Bellotti M, Pennati G, De Gasperi C, Battaglia FC, Ferrazzi E. Role of ductus venosus in distribution of umbilical blood flow in human fetuses during second half of pregnancy. Am J Physiol Heart Circ Physiol 2000; 279: H1256-1263.
23. Kiserud T, Kilavuz O, Hellevik LR. Venous pulsation in the fetal left portal branch: the effect of pulse and flow direction. Ultrasound Obstet Gynecol 2003; 21: 359-364.
24. Edelstone DI, Rudolph AM. Preferential streaming of ductus venosus blood to the brain and heart in fetal lambs. Am J Physiol 1979; 237: H724-729.
25. Schmidt KG, Silverman NH, Rudolph AM. Assessment of flow events at the ductus venosus-inferior vena cava junction and at the foramen ovale in fetal sheep by use of multimodal ultrasound. Circulation 1996; 93: 826-833.
26. Kiserud T, Eik-Nes SH, Blaas HG, Hellevik LR. Foramen ovale: an ultrasonographic study of its relation to the inferior vena cava, ductus venosus and hepatic veins. Ultrasound Obstet Gynecol 1992; 2: 389-396.
27. Rizzo G, Capponi A, Talone PE, Arduini D, Romanini C. Doppler indices from inferior vena cava and ductus venosus in predicting pH and oxygen tension in umbilical blood at cordocentesis in growth-retarded fetuses. Ultrasound Obstet Gynecol 1996; 7: 401-410.
28. Baschat AA. Relationship between placental blood flow resistance and precordial venous Doppler indices. Ultrasound Obstet Gynecol 2003; 22: 561-566.
29. Baschat AA, Guclu S, Kush ML, Gembruch U, Weiner CP, Harman CR. Venous Doppler in the prediction of acid-base status of growth-restricted fetuses with elevated placental blood flow resistance. Am J Obstet Gynecol 2004; 191: 277-284.
30. Ott WJ. Value of inferior vena cava Doppler waveform analysis for prediction of neonatal outcome. Am J Perinatol 1999; 16: 429-434.
31. Hecher K, Campbell S, Snijders R, Nicolaides K. Reference ranges for fetal venous and atrioventricular blood flow parameters. Ultrasound Obstet Gynecol 1994; 4: 381-390.
32. Rizzo G, Arduini D, Romanini C. Umbilical vein pulsations: a physiologic finding in early gestation. Am J Obstet Gynecol 1992; 167: 675-677.
33. van Splunder IP, Huisman TW, Stijnen T, Wladimiroff JW. Presence of pulsations and reproducibility of waveform recording in the umbilical and left portal vein in normal pregnancies. Ultrasound Obstet Gynecol 1994; 4: 49-53.
34. nd edn), Yagel S, Silverman NH, Gembruch U (eds). Informa Healthcare: New York, 2009; 547-560.
35. Behrman RE, Lees MH, Peterson EN, De Lannoy CW, Seeds AE. Distribution of the circulation in the normal and asphyxiated fetal primate. Am J Obstet Gynecol 1970; 108: 956-969.
36. Edelstone DI, Rudolph AM, Heymann MA. Effects of hypoxemia and decreasing umbilical flow on liver and ductus venosus blood flows in fetal lambs. Am J Physiol 1980; 238: H656-663.
37. 2 delivery. Am J Physiol 1987; 252: H100-109.
38. Meyers RL, Paulick RP, Rudolph CD, Rudolph AM. Cardiovascular responses to acute, severe haemorrhage in fetal sheep. J Dev Physiol 1991; 15: 189-197.
39. Paulick RP, Meyers RL, Rudolph CD, Rudolph AM. Venous and hepatic vascular responses to indomethacin and prostaglandin E1 in the fetal lamb. Am J Obstet Gynecol 1990; 163: 1357-1363.
40. Reed KL, Appleton CP, Anderson CF, Shenker L, Sahn DJ. Doppler studies of vena cava flows in human fetuses. Insights into normal and abnormal cardiac physiology. Circulation 1990; 81: 498-505.
41. Rizzo G, Arduini D, Romanini C. Inferior vena cava flow velocity waveforms in appropriate- and small-for-gestational-age fetuses. Am J Obstet Gynecol 1992; 166: 1271-1280.
42. Huisman TW, Stewart PA, Wladimiroff JW, Stijnen T. Flow velocity waveforms in the ductus venosus, umbilical vein and inferior vena cava in normal human fetuses at 12-15 weeks of gestation. Ultrasound Med Biol 1993; 19: 441-445.
43. Huisman TW, Stewart PA, Wladimiroff JW. Flow velocity waveforms in the fetal inferior vena cava during the second half of normal pregnancy. Ultrasound Med Biol 1991; 17: 679-682.
44. Axt-Fliedner R, Wiegank U, Fetsch C, Friedrich M, Krapp M, Georg T, Diedrich K. Reference values of fetal ductus venosus, inferior vena cava and hepatic vein blood flow velocities and waveform indices during the second and third trimester of pregnancy. Arch Gynecol Obstet 2004; 270: 46-55.
45. Mari G, Uerpairojkit B, Copel JA. Abdominal venous system in the normal fetus. Obstet Gynecol 1995; 86: 729-733.
46. Hofstaetter C, Gudmundsson S, Dubiel M, Marsal K. Fetal right hepatic venous blood velocimetry in normal and high-risk pregnancies. Eur J Ultrasound 1996; 4: 153-160.
47. Haugen G, Kiserud T, Godfrey K, Crozier S, Hanson M. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol 2004; 24: 599-605.
48. Acharya G, Wilsgaard T, Rosvold Berntsen GK, Maltau JM, Kiserud T. Reference ranges for umbilical vein blood flow in the second half of pregnancy based on longitudinal data. Prenat Diagn 2005; 25: 99-111.
49. Kiserud T. Physiology of the fetal circulation. Semin Fetal Neonatal Med 2005; 10: 493-503.
50. Kessler J, Rasmussen S, Kiserud T. The fetal portal vein: normal blood flow development during the second half of human pregnancy. Ultrasound Obstet Gynecol 2007; 30: 52-60.
51. Yagel S, Cohen SM, Shapiro I, Valsky DV. 3D and 4D ultrasound in fetal cardiac scanning: a new look at the fetal heart. Ultrasound Obstet Gynecol 2007; 29: 81-95.
52. Kim SH, Lee JM, Kim YJ, Lee JY, Han JK, Choi BI. High-definition flow Doppler ultrasonographic technique to assess hepatic vasculature compared with color or power Doppler ultrasonography: preliminary experience. J Ultrasound Med 2008; 27: 1491-1501.
53. Abuhamad A. Automated multiplanar imaging: a novel approach to ultrasonography. J Ultrasound Med 2004; 23: 573-576.
54. Abuhamad A, Falkensammer P, Reichartseder F, Zhao Y. Automated retrieval of standard diagnostic fetal cardiac ultrasound planes in the second trimester of pregnancy: a prospective evaluation of software. Ultrasound Obstet Gynecol 2008; 31: 30-36.
55. Chaoui R, Hoffmann J, Heling KS. Three-dimensional (3D) and 4D color Doppler fetal echocardiography using spatio-temporal image correlation (STIC). Ultrasound Obstet Gynecol 2004; 23: 535-545.
56. Chaoui R, Kalache KD. Three-dimensional power Doppler ultrasound of the fetal great vessels. Ultrasound Obstet Gynecol 2001; 17: 455-456.
57. Chaoui R, Kalache KD, Hartung J. Application of three-dimensional power Doppler ultrasound in prenatal diagnosis. Ultrasound Obstet Gynecol 2001; 17: 22-29.
58. Espinoza J, Goncalves LF, Lee W, Mazor M, Romero R. A novel method to improve prenatal diagnosis of abnormal systemic venous connections using three- and four-dimensional ultrasonography and 'inversion mode'. Ultrasound Obstet Gynecol 2005; 25: 428-434.
59. Goncalves LF, Espinoza J, Lee W, Nien JK, Hong JS, Santolaya-Forgas J, Mazor M, Romero R. A new approach to fetal echocardiography: digital casts of the fetal cardiac chambers and great vessels for detection of congenital heart disease. J Ultrasound Med 2005; 24: 415-424.
60. Goncalves LF, Romero R, Espinoza J, Lee W, Treadwell M, Chintala K, Brandl H, Chaiworapongsa T. Four-dimensional ultrasonography of the fetal heart using color Doppler spatiotemporal image correlation. J Ultrasound Med 2004; 23: 473-481.
61. Sciaky-Tamir Y, Cohen SM, Hochner-Celnikier D, Valsky DV, Messing B, Yagel S. Three-dimensional power Doppler (3DPD) ultrasound in the diagnosis and follow-up of fetal vascular anomalies. Am J Obstet Gynecol 2006; 194: 274-281.