Ductus venosus shunting in the fetal venous circulation: Regulatory mechanisms, diagnostic methods and medical importance

University of Hamburg, Hamburg, Hamburg, Germany
Ultrasound in Obstetrics and Gynecology (Impact Factor: 3.85). 04/2006; 27(4):452-61. DOI: 10.1002/uog.2747
Source: PubMed


The fetal liver is located at the crossroads of the umbilical venous circulation. Anatomically, the ductus venosus (DV) and the intrahepatic branches of the portal vein are arranged in parallel. The actual DV shunting rate, i.e. the percentage of umbilical blood flow entering the DV measured by Doppler velocimetry, seems to be lower than that estimated using radioactively-labeled microspheres. In human fetuses the DV shunting rate is about 20–30%. Increases in the DV shunting rate are a general adaptational mechanism to fetal distress. Hypoxia results in a significant increase in the DV shunting rate, most probably in order to ensure an adequate supply of oxygen and glucose to vitally important organs such as the brain and heart. The mechanism of blood flow redistribution between the fetal liver and the DV is still a matter of debate. The isthmic portion of the DV contains less smooth muscle tissue than the intrahepatic branches of the portal vein, which in vitro react more forcefully in response to catecholamines than the DV.
In growth-restricted human fetuses DV shunting is increased and the umbilical blood supply to the fetal liver is reduced. The long-term reduction of the hepatic blood supply may be involved in fetal growth restriction. The occlusion of the DV leads to a significant increase in cell proliferation in fetal skeletal muscle, heart, kidneys and liver, and possibly to an increase in insulin-like growth factor (IGF)-I and -II mRNA expression in the fetal liver. These findings hint at the possible role of the perfusion of the fetal liver in the control of the growth process.
The quantification of DV shunting by Doppler velocimetry may improve the early recognition of fetal compromise in prenatal medicine. In this Review we summarize the published data on the anatomical structure and histology of the DV, the mechanisms of regulation of DV shunting, its role in fetal survival and growth and the possible use of the measurement of DV shunting in clinical practice. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.

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    • "The DV is a fetal shunt that connects the umbilical vein with the inferior vena cava, allowing a large proportion of well-oxygenated umbilical vein blood to bypass the portal system and reach the central circulation (Fig. 1) [10] [11] [12]. It is estimated that 18%–50% of umbilical blood flow is shunted through the DV in the human fetus [13], with the flow decreasing as gestational age progresses [12] [14]. With postpartum closure of the umbilical vein, the blood flow and blood pressure in the umbilical vein decrease abruptly, but the DV remains open for a variable amount of time as a porto-systemic shunt. "
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    ABSTRACT: The etiology of necrotizing enterocolitis (NEC) remains elusive and no definite trigger has been identified. There are no studies to date examining the potential role of closure of the ductus venosus (DV), its effect on increasing portal venous pressure (PVP) and its association to mesenteric venous ischemia in the development of NEC. Our aim was to develop an animal model to examine this physiology. Fifteen near-term lambs were used. The DV was occluded in experimental animals by a balloon tip catheter, while the sham controls underwent catheterization without DV occlusion. Vital signs and PVP were monitored for 4h, followed by intestinal biopsy. The experimental group (n=5) demonstrated a significant increase in PVP following DV occlusion (11.87mm Hg [95% CI: 11.40-12.34]), compared to controls (8.95mm Hg [95% CI: 8.34-9.56]) (F=12.16, p=0.001). Histology of the terminal ileum showed vacuolar degeneration, indicative of reversible cellular damage in the experimental group. We demonstrate that DV closure in the neonatal lamb leads to transient portal hypertension which is associated with cellular damage and inflammatory changes of the intestinal mucosa. Additional studies will be necessary to determine if the transient portal hypertension following DV closure leads to clinically apparent intestinal ischemia and NEC.
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    • "A description of the ideal technique for measuring blood flow in both UV and DV has been published (Tchirikov et al. 2006). For UV blood volume flow measurement, a straight segment of the intraabdominal part of the UV upstream of any hepatic branches should be selected, with the Doppler gate positioned so as to completely cover the vessel's diameter. "

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    ABSTRACT: Die Darstellung der venösen Blutgefäße gelingt am besten mittels Farbdopplersonographie in bestimmten sagittalen und transversalen Schnittebenen durch das fetale Abdomen. Der mittsagittale Schnitt erlaubt die beste Darstellungsmöglichkeit für den Ductus venosus, der in direkter Verlängerung der V. umbilicalis steil ansteigend zum Herz verläuft. Sein Ursprung liegt an der Stelle, wo der kranialwärts gerichtete subhepatische Verlauf der V. umbilicalis sich in einen horizontal nach rechts gerichteten, zur Vereinigung mit den Portalvenen, verändert. Die Mündungsstelle an der V. cava inferior stellt eine Erweiterung vor dem rechten Vorhof dar, in die auch die hepatischen Venen einmünden. Die V. cava inferior läuft parallel zur Wirbelsäule rechts vor der Aorta abdominalis und in ihrem letzten Abschnitt in leicht anteriorer Richtung zum rechten Vorhof ( Abb. 15.1). In einer schrägen Querschnittsebene durch das Abdomen lassen sich ebenfalls V. umbilicalis und Ductus venosus darstellen. Die 3 Hauptstämme der hepatischen Venen sind in einer etwas kranial gelegenen transversalen Ebene darstellbar.
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