Ductus venosus

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Ductus venosus
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Fetal circulation. The ductus venosus (red) connects the umbilical vein to the inferior vena cava .
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The liver and the veins in connection with it, of a human embryo, twenty-four or twenty-five days old, as seen from the ventral surface.
Details
Source Umbilical vein
Drains to Inferior vena cava
Artery Ductus arteriosus
Identifiers
Latin ductus venosus
Anatomical terminology

In the fetus, the ductus venosus (Arantius' duct after Julius Caesar Aranzi [1] ) shunts a portion of umbilical vein blood flow directly to the inferior vena cava. [2] Thus, it allows oxygenated blood from the placenta to bypass the liver. Compared to the 50% shunting of umbilical blood through the ductus venosus found in animal experiments, the degree of shunting in the human fetus under physiological conditions is considerably less, 30% at 20 weeks, which decreases to 18% at 32 weeks, suggesting a higher priority of the fetal liver than previously realized. [3] In conjunction with the other fetal shunts, the foramen ovale and ductus arteriosus , it plays a critical role in preferentially shunting oxygenated blood to the fetal brain. It is a part of fetal circulation.

Contents

Anatomic course

The pathway of fetal umbilical venous flow is umbilical vein to left portal vein to ductus venosus to inferior vena cava and eventually the right atrium. This anatomic course is important in the assessment of neonatal umbilical venous catheterization, as failure to cannulate through the ductus venosus results in malpositioned hepatic catheterization via the left or right portal veins. Complications of such positioning can include hepatic hematoma or abscess.

Postnatal closure

The ductus venosus is open at the time of birth and that is the reason why umbilical vein catheterization works. The ductus venosus naturally closes during the first week of life in most full-term neonates; however, it may take much longer to close in pre-term neonates. Functional closure occurs within minutes of birth. Structural closure in term babies occurs within 3 to 7 days.

After it closes, the remnant is known as ligamentum venosum .

If the ductus venosus fails to occlude after birth, it remains patent (open), and the individual is said to have a patent ductus venosus and thus an intrahepatic portosystemic shunt (PSS). [4] This condition is hereditary in some dog breeds (e.g. Irish Wolfhound). The ductus venosus shows a delayed closure in preterm infants, with no significant correlation to the closure of the ductus arteriosus or the condition of the infant. [5] Possibly, increased levels of dilating prostaglandins leads to a delayed occlusion of the vessel. [5]

Agenesis of ductus venosus (ADV) in a first trimester case with umbilical vein drainage into inferior vena cava (IVC) and increased nuchal translucency. (A): Transverse plane of the FT fetal abdomen, with high-definition directional power Doppler applied. An "H"-shaped variant of the intrahepatic portal veins connection is identified; (B): high-definition directional power Doppler in the sagittal plane of the fetal abdomen (same case) showing ADV with umbilical vein drainage into the inferior vena cava; (C): mid-sagittal view of the fetal face with the measurement of the thickened NT. MPV main portal vein, St stomach, LPV left portal vein, UV umbilical vein, RPVa anterior branch of right portal vein, RPVp posterior branch of right portal vein, Ao aorta, IVC inferior vena cava, ADV ductus venosus agenesis, P palate, NB nasal bone, NT nuchal translucency. Agenesis of ductus venosus human.jpg
Agenesis of ductus venosus (ADV) in a first trimester case with umbilical vein drainage into inferior vena cava (IVC) and increased nuchal translucency. (A): Transverse plane of the FT fetal abdomen, with high-definition directional power Doppler applied. An ”H”-shaped variant of the intrahepatic portal veins connection is identified; (B): high-definition directional power Doppler in the sagittal plane of the fetal abdomen (same case) showing ADV with umbilical vein drainage into the inferior vena cava; (C): mid-sagittal view of the fetal face with the measurement of the thickened NT. MPV main portal vein, St stomach, LPV left portal vein, UV umbilical vein, RPVa anterior branch of right portal vein, RPVp posterior branch of right portal vein, Ao aorta, IVC inferior vena cava, ADV ductus venosus agenesis, P palate, NB nasal bone, NT nuchal translucency.

Related Research Articles

<span class="mw-page-title-main">Umbilical cord</span> Conduit between embryo/fetus and the placenta

In placental mammals, the umbilical cord is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologically and genetically part of the fetus and normally contains two arteries and one vein, buried within Wharton's jelly. The umbilical vein supplies the fetus with oxygenated, nutrient-rich blood from the placenta. Conversely, the fetal heart pumps low-oxygen, nutrient-depleted blood through the umbilical arteries back to the placenta.

<span class="mw-page-title-main">Patent ductus arteriosus</span> Condition wherein the ductus arteriosus fails to close after birth

Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs through the aorta, which has a higher blood pressure, to the pulmonary artery, which has a lower blood pressure. Symptoms are uncommon at birth and shortly thereafter, but later in the first year of life there is often the onset of an increased work of breathing and failure to gain weight at a normal rate. With time, an uncorrected PDA usually leads to pulmonary hypertension followed by right-sided heart failure.

<span class="mw-page-title-main">Umbilical vein</span> Vein running from the placenta to the fetus

The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood volume and for administration of glucose and drugs.

<span class="mw-page-title-main">Atrial septal defect</span> Human heart defect present at birth

Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the foramen ovale; however, when this does not naturally close after birth it is referred to as a patent (open) foramen ovale (PFO). It is common in patients with a congenital atrial septal aneurysm (ASA).

<span class="mw-page-title-main">Ductus arteriosus</span> Blood vessel connecting the pulmonary artery to the proximal descending aorta

The ductus arteriosus, also called the ductus Botalli, named after the Italian physiologist Leonardo Botallo, is a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs. Upon closure at birth, it becomes the ligamentum arteriosum.

At the end of pregnancy, the fetus must take the journey of childbirth to leave the reproductive mother. Upon its entry to the air-breathing world, the newborn must begin to adjust to life outside the uterus. This is true for all viviparous animals; this article discusses humans as the most-researched example.

<span class="mw-page-title-main">Hypoplastic left heart syndrome</span> Type of congenital heart defect

Hypoplastic left heart syndrome (HLHS) is a rare congenital heart defect in which the left side of the heart is severely underdeveloped and incapable of supporting the systemic circulation. It is estimated to account for 2-3% of all congenital heart disease. Early signs and symptoms include poor feeding, cyanosis, and diminished pulse in the extremities. The etiology is believed to be multifactorial resulting from a combination of genetic mutations and defects resulting in altered blood flow in the heart. Several structures can be affected including the left ventricle, aorta, aortic valve, or mitral valve all resulting in decreased systemic blood flow.

<span class="mw-page-title-main">Transposition of the great vessels</span> Group of congenital heart defects

Transposition of the great vessels (TGV) is a group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferior venae cavae, pulmonary artery, pulmonary veins, and aorta. Congenital heart diseases involving only the primary arteries belong to a sub-group called transposition of the great arteries (TGA), which is considered the most common congenital heart lesion that presents in neonates.

<span class="mw-page-title-main">Hepatic veins</span> One of two sets of veins connected to the liver

In human anatomy, the hepatic veins are the veins that drain venous blood from the liver into the inferior vena cava. There are usually three large upper hepatic veins draining from the left, middle, and right parts of the liver, as well as a number (6-20) of lower hepatic veins. All hepatic veins are valveless.

<span class="mw-page-title-main">Tricuspid atresia</span> Medical condition

Tricuspid atresia is a form of congenital heart disease whereby there is a complete absence of the tricuspid valve. Therefore, there is an absence of right atrioventricular connection. This leads to a hypoplastic (undersized) or absent right ventricle. This defect is contracted during prenatal development, when the heart does not finish developing. It causes the systemic circulation to be filled with relatively deoxygenated blood. The causes of tricuspid atresia are unknown.

<span class="mw-page-title-main">Foramen ovale (heart)</span> Passageway between the atria of the human heart

In the fetal heart, the foramen ovale, also foramen Botalli or the ostium secundum of Born, allows blood to enter the left atrium from the right atrium. It is one of two fetal cardiac shunts, the other being the ductus arteriosus. Another similar adaptation in the fetus is the ductus venosus. In most individuals, the foramen ovale closes at birth. It later forms the fossa ovalis.

<span class="mw-page-title-main">Transjugular intrahepatic portosystemic shunt</span> Artificial channel within the liver

Transjugular intrahepatic portosystemic shunt is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension which frequently leads to intestinal bleeding, life-threatening esophageal bleeding and the buildup of fluid within the abdomen (ascites).

<span class="mw-page-title-main">Fetal circulation</span> Circulatory system of fetuses

In humans, the circulatory system is different before and after birth. The fetal circulation is composed of the placenta, umbilical blood vessels encapsulated by the umbilical cord, heart and systemic blood vessels. A major difference between the fetal circulation and postnatal circulation is that the lungs are not used during the fetal stage resulting in the presence of shunts to move oxygenated blood and nutrients from the placenta to the fetal tissue. At birth, the start of breathing and the severance of the umbilical cord prompt various changes that quickly transform fetal circulation into postnatal circulation.

Placental insufficiency or utero-placental insufficiency is the failure of the placenta to deliver sufficient nutrients to the fetus during pregnancy, and is often a result of insufficient blood flow to the placenta. The term is also sometimes used to designate late decelerations of fetal heart rate as measured by cardiotocography or an NST, even if there is no other evidence of reduced blood flow to the placenta, normal uterine blood flow rate being 600mL/min.

<span class="mw-page-title-main">Umbilical line</span>

An umbilical line is a catheter that is inserted into one of the two arteries or the vein of the umbilical cord. Generally the UAC/UVC is used in Neonatal Intensive Care Units (NICU) as it provides quick access to the central circulation of premature infants. UAC/UVC lines can be placed at the time of birth and allow medical staff to quickly infuse fluids, inotropic drugs, and blood if required. It is sometimes used in term or near-term newborns in whom the umbilical cord stump is still connected to the circulatory system. Medications, fluids, and blood can be given through this catheter and it allows monitoring of blood gasses and withdrawing of blood samples. Transumbilical catheter intervention is also a method of gaining access to the heart, for example to surgically correct a patent ductus arteriosus.

A fetus or foetus is the unborn offspring that develops from a mammal embryo. Following embryonic development, the fetal stage of development takes place. In human prenatal development, fetal development begins from the ninth week after fertilization and continues until the birth of a newborn. Prenatal development is a continuum, with no clear defining feature distinguishing an embryo from a fetus. However, a fetus is characterized by the presence of all the major body organs, though they will not yet be fully developed and functional and some not yet situated in their final anatomical location.

<span class="mw-page-title-main">Anomalous pulmonary venous connection</span> Medical condition

Anomalous pulmonary venous connection is a congenital defect of the pulmonary veins.

<span class="mw-page-title-main">Hypoplastic right heart syndrome</span> Type of congenital heart disease

Hypoplastic right heart syndrome or HRHS is a congenital heart defect in which the structures on the right side of the heart, particularly the right ventricle, are underdeveloped. This defect causes inadequate blood flow to the lungs, and thus a cyanotic infant.

Crista dividens is a structure in the developing heart of the human embryo that divides the right atrium in a way such that it creates a pan systolic murmur in the same way as the foramen ovale. Recognition of the absence of this murmur can indicate a potentially terminal cardiac defect in the newborn.

<span class="mw-page-title-main">Heart development</span> Prenatal development of the heart

Heart development, also known as cardiogenesis, refers to the prenatal development of the heart. This begins with the formation of two endocardial tubes which merge to form the tubular heart, also called the primitive heart tube. The heart is the first functional organ in vertebrate embryos.

References

  1. "Whonamedit - dictionary of medical eponyms". www.whonamedit.com.
  2. Kiserud, T.; Rasmussen, S.; Skulstad, S. (2000). "Blood flow and the degree of shunting through the ductus venosus in the human fetus". American Journal of Obstetrics and Gynecology. 182 (1 Pt 1): 147–153. doi:10.1016/S0002-9378(00)70504-7. PMID   10649170.
  3. Kiserud, T (2000). "Fetal venous circulation -- an update on hemodynamics". J Perinat Med. 28 (2): 90–6. doi:10.1515/JPM.2000.011. PMID   10875092. S2CID   11799576.
  4. Online Mendelian Inheritance in Man, Patent ductus venosus; PDV.
  5. 1 2 Fugelseth D, Lindemann R, Liestøl K, Kiserud T, Langslet A (December 1998). "Postnatal closure of ductus venosus in preterm infants ≤32 weeks. An ultrasonographic study". Early Hum. Dev. 53 (2): 163–9. doi:10.1016/s0378-3782(98)00051-6. PMID   10195709.