J Ultrasound Med 2007;
26:1077–1082 ¥ 0278-4297/07/$3.50
Diagnosis of Absent Ductus Venosus in a Population
Referred for Fetal Echocardiography
Association With a
Persistent Portosystemic Shunt Requiring Postnatal Device Occlusion
Authors
Ruben J Acherman, MD, William N Evans, MD, Alvaro Galindo, MD,
Juan C Collazos, MD, Abraham Rothman, MD, Gary A Mayman, MD, Carlos F Luna, MD,
Robert Rollins, MD, Katrinka T Kip, MD, Dean P Berthody, MD, FABR, Humberto
Restrepo, MD, MPH
Source
Children's Heart Center Nevada, 3006 S Maryland Pkwy, Ste 690, Las
Vegas, Nevada 89109, USA. Email: iacherman@aol.com.
Abstract
Objective. The purpose of this
series was to assess the incidence, anatomic variants, and implications of an
absent ductus venosus (ADV) in patients referred for fetal echocardiography.
Methods. We searched our
fetal cardiology database for diagnoses of ADV from May 2003 to December 2006.
Results. During the study
period, we performed 1328 fetal echocardiographic examinations in 990 fetuses.
We found 6 cases of ADV (6/1000). Indications for fetal echocardiography were
cardiomegaly, dilated umbilical or systemic veins, and extracardiac
abnormalities. We identified 5 anatomic variants of ADV. In 2 patients, the
umbilical vein connected to the systemic venous circulation by way of the
portal sinus: via an abnormal venous channel from the portal sinus to the right
atrium (case 1) and presumably via hepatic sinusoids to the hepatic veins (case
2). In the remaining 4 patients, the umbilical vein by passed the portal sinus
and the liver and connected to the systemic venous circulation via an abnormal venous
channel: from the umbilical vein to the right atrium (case 3), from the
umbilical vein to the inferior vena cava (cases 4 and 5), and from the
umbilical vein to the right iliac vein (case 6). All patients survived; 2
required cardiovascular intervention. No intervention was required in 3
patients.
Conclusions. An ADV should be
ruled out in a fetus with unexplained cardiomegaly or dilatation of the umbilical
vein, systemic veins, or portal sinus. To our knowledge, prenatal diagnosis of
an ADV with an abnormal communication between the portal sinus and the right
atrium has not been reported previously. The portosystemic communication
persisted after birth and required device occlusion.