Sonographic features of umbilical vein recanalization for a Rex shunt on cavernous transformation of portal vein in children
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Sonographic features of umbilical vein recanalization for a Rex shunt on cavernous transformation of portal vein in childrenKeywords:
Ductus venosus
Portosystemic shunt
Abstract To evaluate intraabdominal course of umbilical vein, its relation with portal vein and ductus venosus and its anomalies. All pregnant women were examined during midtrimester anomaly scan between January 2015 and December 2017. With evaluation of umbilical vein in its intraabdominal course, size of umbilical vein, its relation to the stomach and the gallbladder and origin of ductus venosus were studied in middle and upper abdominal axial and sagittal planes by two dimensional and colour doppler sonography. Anastomosis of umbilical vein with portal vein and its further course was examined and detailed anatomical survey was made to look for associated anomalies. Fetal and neonatal outcome was assessed after delivery. Twelve cases of umbilical vein abnormalities were evaluated. Of them, there were three cases of umbilical vein varix, four cases of persistent right umbilical vein and five cases of abnormal umbilical–portal–systemic venous shunt were noted. Examination of the intraabdominal course of umbilical vein and ductus venosus should be a part of second trimester anomaly scan. Proper knowledge of umbilical portal venous system is mandatory.
Ductus venosus
Navel
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Agenesis of the ductus venosus (ADV) is a rare condition in which there are two variants of umbilical vein drainage: intrahepatic shunt or extrahepatic (portosystemic) shunt. It has been posited that the extrahepatic variant carries a poorer prognosis. However, in the absence of associated anomalies there is still a wide variation in outcome. We evaluated the portal system in cases of ADV and aimed to identify parameters that might predict outcome.We conducted a retrospective study of cases of ADV with extrahepatic shunt that had been examined in two centers, and collected new cases prospectively. The route of the shunt was depicted using two-dimensional (2D) and three-dimensional (3D) ultrasound imaging. In an attempt to characterize portal system and shunt developmental variations and their possible impact on outcome, the diameter of the shunt was compared with the diameter of the umbilical vein and the entire portal vasculature was assessed. Poor outcome was defined as persistent morbidity or fetal or neonatal death.Twenty-two cases of ADV were identified: nine retrospectively and 13 prospectively. Aberrant shunts from the umbilical vein were identified to the right atrium, coronary sinus, inferior vena cava (IVC) and iliac vein. In seven of 22 cases (32%) a wide connection was observed. In six of these seven cases (86%) the outcome was poor, including four with severe associated anomalies and two with hepatic dysfunction. In five of these cases, cardiomegaly with tricuspid regurgitation was observed, as well as underdevelopment of the portal system. In only five of 15 cases with a narrow shunt (33%) was the outcome poor, and in all five cases the poor outcome was related to associated anomalies.In cases of ADV with extrahepatic shunt, portal system development is impacted by the diameter of the shunt. If the shunt is narrow, the portal system will have developed normally. A wide shunt is associated with underdevelopment or absence of the portal system. In cases of ADV with extrahepatic shunt, prognosis is determined by the severity of associated anomalies, the diameter of the shunt and development of the portal system.
Ductus venosus
Portosystemic shunt
Agenesis
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To explore the umbilical vein branches of the fetal and the quantity of blood passing through the liver and the ductus venosus. Method Sixty two normal fetal livers were chosen after being fixed with formalin. The branches of umbilical vein were anatomized, observed and measured.Results There was a significant difference of the total cross section area between the umbilical vein branches pass through the liver and the ductus venosus (P0. 001). The sectional area passing through the liver conclusion was larger than that of ductus venosus.Conclusion In the fetal, the great majority of umbilical blood passes through the liver to in ferior vena cava and only small part flows into the ductus venosus. There is over two - thirds umbilical vein blood passing through the 1iver to left lobe.
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Abstract We describe a rare congenital portosystemic shunt. A 37-year-old woman was found to have a previously unreported congenital shunt following investigations into secondary causes of hypertension. The abnormal venous shunt connected the splenic vein to the left ovarian vein. The patient underwent a laparoscopic procedure to successfully divide the shunt. She made a full recovery without complications. To our knowledge, this is the first presentation of a congenital portosystemic shunt involving the splenic and ovarian veins to be reported. This case demonstrates that such a shunt can be amenable for laparoscopic management. The case report shows preoperative scans and intraoperative images.
Portosystemic shunt
Presentation (obstetrics)
Portography
Splenic vein
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Summary Agenesis of the ductus venosus (ADV) is a rare congenital vascular abnormality. ADV is associated with drainage of blood from the umbilical vein into the right atrium and an abnormal connection of the portal vein to the umbilical vein which acts as a post‐natal portosystemic shunt. We report delayed emergence from anaesthesia in a patient with ADV and a portosystemic shunt, perhaps caused by fentanyl. In patients with ADV and a portosystemic shunt, it is important to consider possible prolonged effects of drugs that are metabolised in the liver.
Ductus venosus
Portosystemic shunt
Agenesis
Abnormality
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Ductus venosus
Portosystemic shunt
Portography
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Citations (59)
Abstract Anomalies of the fetal umbilical vessels are rare, excepting single umbilical arteries which occur in 0.2–1.0% of pregnancies1. Abnormalities of the intra‐abdominal umbilical vein may be categorized into three main groups: (1) the ductus venosus is patent but the right umbilical vein persists; (2) the ductus venosus is not patent, and there is extrahepatic continuation of the umbilical vein; and (3) the umbilical vein takes a normal course but is abnormally dilated. We describe cases of each of these types of anomaly, including the first report of prenatal diagnosis of insertion of the umbilical vein into the iliac vein, and review the literature on this subject. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Ductus venosus
Navel
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Ductus venosus
Portosystemic shunt
Sinus venosus
Portal venous system
Ampulla
Portography
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Congenital extrahepatic portosystemic shunts are anomalous vessels joining portal and systemic venous circulation. These shunts are often diagnosed sonographically, but computed tomography (CT) angiography produces high-resolution images that give a more comprehensive overview of the abnormal portal anatomy. CT angiography was performed on 25 dogs subsequently proven to have an extrahepatic portosystemic shunt. The anatomy of each shunt and portal tributary vessels was assessed. Three-dimensional images of each shunt type were created to aid understanding of shunt morphology. Maximal diameter of the extrahepatic portosystemic shunt and portal vein cranial and caudal to shunt origin was measured. Six general shunt types were identified: splenocaval, splenoazygos, splenophrenic, right gastric-caval, right gastric-caval with a caudal shunt loop, and right gastric-azygos with a caudal shunt loop. Slight variations of tributary vessels were seen within some shunt classes, but were likely clinically insignificant. Two shunt types had large anastomosing loops whose identification would be important if surgical correction were attempted. A portal vein could not be identified cranial to the shunt origin in two dogs. In conclusion, CT angiography provides an excellent overview of extrahepatic portosystemic shunt anatomy, including small tributary vessels and loops. With minor variations, most canine extrahepatic portosystemic shunts will likely be one of six general morphologies.
Portosystemic shunt
Portography
Portacaval shunt
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