Ultrasound of the Fetal Veins Part 1: The Intrahepatic Venous System

Learning objectives

1. The examination of the intrahepatic fetal veins includes the evaluation of the umbilical vein, the portal venous system, the ductus venosus, the hepatic veins and the inferior vena cava.

2. The complex anatomy of the afferent and efferent veins is explained using schemes, 2 D grayscale, color Doppler and 3 D color Doppler images.

3. Typical abnormal findings are demonstrated and include the right umbilical vein, umbilical vein varix, different forms of agenesis of the ductus venosus and other rare intrahepatic vascular anomalies.

4. The spectral Doppler examination of the veins focused mainly on the assessment of the ductus venosus flow in fetuses with increased right atrial preload, in screening for aneuploidies in early gestation, in cardiac anomalies as well as in fetuses with severe growth restriction.

• References/Literatur

• 1 Achiron R, Hegesh J, Yagel S et al. Abnormalities of the fetal central veins and umbilico-portal system: prenatal ultrasonographic diagnosis and proposed classification. Ultrasound Obstet Gynecol 2000; 16: 539-548
• 2 Yagel S, Kivilevitch Z, Cohen SM et al. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. Ultrasound Obstet Gynecol 2010; 36: 93-111
• 3 Yagel S, Kivilevitch Z, Cohen SM et al. The fetal venous system, part I: normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation. Ultrasound Obstet Gynecol 2010; 35: 741-750
• 4 Shen O, Valsky DV, Messing B et al. Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis. Ultrasound Obstet Gynecol 2011; 37: 184-190
• 5 Kiserud T, Eik-Nes SH, Blaas HG et al. Ultrasonographic velocimetry of the fetal ductus venosus. Lancet 1991; 338: 1412-1414
• 6 Kiserud T, Eik-Nes SH, Blaas HG et al. 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
• 7 Haugen G, Kiserud T, Godfrey K et al. Portal and umbilical venous blood supply to the liver in the human fetus near term. Ultrasound Obstet Gynecol 2004; 24: 599-605
• 8 Kiserud T. Physiology of the fetal circulation. Semin Fetal Neonatal Med 2005; 10: 493-503
• 9 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
• 10 Mavrides E, Moscoso G, Carvalho JS et al. 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
• 11 Kalache K, Romero R, Goncalves LF et al. Three-dimensional color power imaging of the fetal hepatic circulation. Am J Obstet Gynecol 2003; 189: 1401-1406
• 12 Sinkovskaya E, Klassen A, Abuhamad A. A novel systematic approach to the evaluation of the fetal venous system. Semin Fetal Neonatal Med 2013; 18: 269-278
• 13 Fasouliotis SJ, Achiron R, Kivilevitch Z et al. The human fetal venous system: normal embryologic, anatomic, and physiologic characteristics and developmental abnormalities. J Ultrasound Med 2002; 21: 1145-1158
• 14 Achiron R, Gindes L, Kivilevitch Z et al. Prenatal diagnosis of congenital agenesis of the fetal portal venous system. Ultrasound Obstet Gynecol 2009; 34: 643-652
• 15 Kivilevitch Z, Gindes L, Deutsch H et al. In-utero evaluation of the fetal umbilical-portal venous system: two- and three-dimensional ultrasonic study. Ultrasound Obstet Gynecol 2009; 34: 634-642
• 16 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
• 17 Weichert J, Hartge D, Germer U et al. Persistent right umbilical vein: a prenatal condition worth mentioning?. Ultrasound Obstet Gynecol 2011; 37: 543-548
• 18 Mankuta D, Nadjari M, Pomp G. Isolated fetal intra-abdominal umbilical vein varix: clinical importance and recommendations. J Ultrasound Med 2011; 30: 273-276
• 19 Weissmann-Brenner A, Simchen MJ, Moran O et al. Isolated fetal umbilical vein varix – prenatal sonographic diagnosis and suggested management. Prenat Diagn 2009; 29: 229-233
• 20 Czubalski A, Aleksandrowicz R. Connection types between portal vein and portal sinus during foetal life. Folia Morphol (Warsz) 2000; 59: 97-98
• 21 Berg C, Kamil D, Geipel A et al. Absence of ductus venosus-importance of umbilical venous drainage site. Ultrasound Obstet Gynecol 2006; 28: 275-281
• 22 Achiron R, Gindes L, Gilboa Y et al. Umbilical vein anomaly in fetuses with Down syndrome. Ultrasound Obstet Gynecol 2010; 35: 297-301
• 23 Sau A, Sharland G, Simpson J. Agenesis of the ductus venosus associated with direct umbilical venous return into the heart – case series and review of literature. Prenat Diagn 2004; 24: 418-423
• 24 Staboulidou I, Pereira S, de-Jesus-Cruz J et al. Prevalence and outcome of absence of ductus venosus at 11(+0) to 13(+6) weeks. Fetal Diagn Ther 2011; 30: 35-40
• 25 Guerin F, Blanc T, Gauthier F et al. Congenital portosystemic vascular malformations. Semin Pediatr Surg 2012; 21: 233-244
• 26 Lautz TB, Tantemsapya N, Rowell E et al. Management and classification of type II congenital portosystemic shunts. J Pediatr Surg 2011; 46: 308-314
• 27 Tseng JJ, Chou MM, Lee YH et al. Prenatal diagnosis of intrahepatic arteriovenous shunts. Ultrasound Obstet Gynecol 2000; 15: 441-444
• 28 Hartung J, Chaoui R, Kalache K et al. Prenatal diagnosis of intrahepatic communications of the umbilical vein with atypical arteries (A-V fistulae) in two cases of trisomy 21 using color Doppler ultrasound. Ultrasound Obstet Gynecol 2000; 16: 271-274
• 29 Gill RW, Trudinger BJ, Garrett WJ et al. Fetal umbilical venous flow measured in utero by pulsed Doppler and B-mode ultrasound. I. Normal pregnancies. Am J Obstet Gynecol 1981; 139: 720-725
• 30 Baschat AA. Ductus venosus Doppler for fetal surveillance in high-risk pregnancies. Clin Obstet Gynecol 2010; 53: 858-868
• 31 Matias A, Gomes C, Flack N et al. Screening for chromosomal abnormalities at 10–14 weeks: the role of ductus venosus blood flow. Ultrasound Obstet Gynecol 1998; 12: 380-384
• 32 Matias A, Huggon I, Areias JC et al. Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10–14 weeks. Ultrasound Obstet Gynecol 1999; 14: 307-310
• 33 Khalil A, Nicolaides KH. Fetal heart defects: Potential and pitfalls of first-trimester detection. Semin Fetal Neonatal Med 2013; 18: 251-260