European Journal of Obstetrics & Gynecology and Reproductive Biology
Hemodynamics of the ductus venosus
Section snippets
Functional anatomy
There are good reasons for starting the description of the function of the ductus venosus by describing the foramen ovale and ductus venosus as a unit. In spite of a large body of documentation of this functional relationship, it is rarely correctly presented in writing nor in figures. Both in conventional ultrasound imaging [1] (Fig. 1), color Doppler [2], and at post mortem examination [3], it is possible to appreciate the narrow trumpet-shaped ductus venosus connecting the umbilical vein to
Degree of shunting
Fetal sheep and monkey experiments using microsphere techniques showed that 50% of the umbilical blood was shunted through the ductus venosus [7], [10], [11], [28]. The fraction was slightly less when using dye dilution methods [29]. Applying the microsphere method in previable human fetuses (≤22 weeks), Rudolph et al. [14] found that 52% of the umbilical flow was shunted through the ductus venosus, but with very wide ranges (8–92%). These fetuses were exteriorised and therefore not under
Neural and endocrine regulation of the shunt
Adrenergic nerves have been traced in the area of the ductus venosus inlet [23], and both an α-adrenergic constriction and a β-adrenergic distention have been reported [24], [41]. Prostaglandins and a peroxidase P450 mechanism show activity in the area and have lead to the assumption that such mechanisms are responsible for the ductus venosus patency during pregnancy and its closure after birth in the same way as for the ductus arteriosus [41], [42], [43], [44], [45], [46]. However, changes in
Fluid dynamic determinants
The pressure gradient between the umbilical vein and the central venous pressure is the driving pressure for the blood flow in the ductus venosus and liver circuit in parallel. In the human fetus this pressure gradient is not known, but we assume that it is close to that measured in the umbilical vein (range 0–11 mmHg) [53], [54], [55], [56]. It has been established that the fetus is capable of varying this pressure by changing the arterial pressure and placental flow [6], [7], [28], [57], [58]
Velocity profile
The blood flows with a low and steady velocity in the umbilical vein. According to fluid dynamic principles, such a flow tends to be laminar with a parabolic profile of the velocity distribution across the vessel [61] (Fig. 6). In a parabolic flow the mean velocity is half of the maximum velocity found in the center of the vessel (Vmean=0.5·Vmax). When the blood enters the ductus venosus, it is accelerated and changes velocity profile. A similar situation is found in the heart. Blood that
Pressure gradient
As mentioned previously, the blood flow through the ductus venosus depends on the pressure drop between the umbilical vein and the IVC (the porto-caval or umbilico-caval pressure gradient). Since the high blood flow velocity at the inlet of the ductus venosus reflects this pressure gradient, it has been suggested that the pressure gradient can be calculated from the velocity using a Bernoulli equation [17]. Computational modeling has shown that less that 30% of the energy dissipates along the
Ductus venosus as a transmitter for pressure waves
In addition to directing blood towards the heart, the ductus venosus is involved in transporting waves away from the heart. This has been exploited in diagnostic Doppler ultrasound. The normal pulsatile pattern of blood velocity in the ductus venosus (Fig. 7a) is substituted by excessive pulsation, particularly due to reduced velocity during atrial contraction, in cases of increased afterload, congestive heart failure or abnormal atrial contractions [67], [68], [69], [70], [71], [72], [73], [74]
Conclusion
The ductus venosus represent a unique section of the circulation previously not well explored, probably due to the insignificant role in clinical medicine in later life. This is in contrast to fetal life where it plays a prominent role regulating the distribution of umbilical venous return. It also offers itself as a diagnostic tool in a vast area of fetal medicine. Knowing how important the distribution of umbilical blood is to the fetus, this should be an area of focus using all the
Condensation
Ductus venosus shunts 30% of umbilical blood towards the heart, and transmits atrial pulsation in the opposite direction, towards the umbilical vein. Both functions are modified by the geometry, mechanical properties, viscosity, and particularly the inlet diameter of this vessel.
Acknowledgments
The text was revised by Dr Tone Scheie Jensen. This work was supported by British Heart Foundation, Norwegian Research Council and Norwegian National Health Association.
References (86)
- et al.
Ultrasonographic velocimetry of the fetal ductus venosus
Lancet
(1991) - et al.
Distribution of the circulation in the normal and asphyxiated fetal primate
Am J Obstet Gynecol
(1970) - et al.
Estimation of the pressure gradient across the fetal ductus venosus based on Doppler velocimetry
Ultrasound Med Biol
(1994) - et al.
Observations on the phrenic nerves and the ductus venosus in human embryos and fetuses
Am J Obstet Gynecol
(1971) - et al.
Blood flow through the ductus venosus in singleton and multifetal pregnancies and in fetuses with intrauterine growth retardation
Am J Obstet Gynecol
(1998) - et al.
The effect of reducing umbilical blood flow on fetal oxygenation
Am J Obstet Gynecol
(1983) - et al.
Umbilical blood flow and its distribution before and during autonomic blockade in fetal lambs
Am J Obstet Gynecol
(1980) - et al.
Venous and hepatic vascular responses to indomethacin and prostaglandin E1 in the fetal lamb
Am J Obstet Gynecol
(1990) - et al.
Normal values for human umbilical venous and amniotic fluid pressure and their alteration by fetal disease
Am J Obstet Gynecol
(1989) - et al.
Umbilical venous pressure in normal, growth-retarded, and anemic fetuses
Am J Obstet Gynecol
(1994)
The umbilical circulation
AmJObstetGynecol
Ductus venosus blood flow velocity waveforms in the human fetus – a doppler study
Ultrasound Med Biol
Umbilical flow distribution to the liver and ductus venosus: an in vitro investigation of the fluid dynamic mechanisms in the fetal sheep
Am J Obstet Gynecol
Computational analysis of the ductus venosus fluid dynamics based on Doppler measurements
Ultrasound Med Biol
Blood flow through the ductus venosus in human fetuses: calculation using Doppler velocimetry and computational findings
Ultrasound Med Biol
The blood velocity profile in the ductus venosus inlet expressed by the mean/maximum velocity ratio
Ultrasound Med Biol
Fetal venous, intracardiac, and arterial blood flow measurements in intrauterine growth retardation: relationship with fetal blood gases
Am J Obstet Gynecol
Longitudinal study in 18 cases of fetal supraventricular tachycardia: Doppler echocardiographic findings and pathophysiologic implications
Am Heart J
Pulsations of the ductus venosus blood velocity and diameter are more pronounced at the outlet than at the inlet
Eur J Obstet Gynecol Reprod Biol
Umbilical vein pulsation: a physiological finding in early gestation
Am J Obstet Gynecol
Venous Doppler ultrasonography in the fetus with nonimmune hydrops
Am J Obstet Gynecol
Flow velocity waveforms in the ductus venosus, umbilical vein and inferior vena cava in normal human fetuses at 12–15 weeks of gestation
Ultrasound Med Biol
Ductus venosus revisited: a Doppler blood flow evaluation in first trimester of pregnancy
Ultrasound Med Biol
Foramen ovale: an ultrasonographic study of its relation to the inferior vena cava, ductus venosus and hepatic veins
Ultrasound Obstet Gynecol
Researches On Pre-natal Life
Functional limitations of the foramen ovale in the human foetal heart
Anat Rec
Foetal and Neonatal Physiology
Distribution and regulation of blood flow in the fetal and neonatal lamb
Circ Res
Angiocardiographic studies on the human foetal circulation
Pediatrics
Human fetal and neonatal circulation
Eur J Cardiol
Liver and ductus venosus blood flows in fetal lambs in utero
Circ Res
Preferential streaming of ductus venosus blood to the brain and heart in fetal lambs
Am J Physiol
The circulation of the fetus in utero. Methods for studying distribution of blood flow, cardiac output and organ blood flow
Circ Res
Studies on the circulation of the previable human fetus
Pediatr Res
Assessment of flow events at the ductus venosus – inferior vena cava junction and at the foramen ovale in fetal sheep by the use of multimodal ultrasound
Circulation
Embryonic development in the human of the sphincter of the ductus venosus
Anat Rec
The mechanism of closure of the ductus venosus
Br J Radiol
The sphincter of the ductus venosus
Anat Rec
The innervation of the umbilical vein in human embryos and fetuses
Am J Anat
Histochemical evidence of an aminergic sphincter mechanism in the ductus venosus of the human fetus
Histochemical and pharmacological studies on amine mechanisms in the umbilical cord, umbilical vein and ductus venosus of the human fetus
Acta Physiol Scand
Autonomic mechanisms in the ductus venosus of the lamb
Am J Physiol
Cited by (81)
Effects of patent ductus venosus on bile acid homeostasis in aryl hydrocarbon receptor (AhR)-null mice
2020, Toxicology and Applied PharmacologyCitation Excerpt :In adults, the portal blood flow is responsible for over 80% of the total hepatic blood flow. However, in the fetus, the ductus venosus diverts a significant portion (25–40%) of the portal blood flow (Kiserud, 1999; Kiserud, 2000). In full-term neonates, the ductus venosus anatomically closes during the first week of life, but premature babies may have a patent ductus venosus (PDV) and its closure may take longer, causing an intrahepatic portosystemic shunt.
Physiological adaptation of the growth-restricted fetus
2018, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :With the progress of fetal hypoxia and increasing central venous pressure, the DV diastolic velocities decrease, the a-wave deepens, and the PI for veins increases. The a-wave eventually reaches the zero-line or even becomes negative (Fig. 5); these changes are late signs of fetal asphyxia and developing acidosis [47,74,76]. The severe DV velocity changes usually precede in time the finding of UV pulsations [77].
Umbilical Circulation
2017, Fetal and Neonatal Physiology, 2-Volume SetFetal Aortic and Umbilical Doppler Flow Velocity Waveforms in Pregnancy: The Concept of Aortoumbilical Column
2024, Current Cardiology ReviewsImportance of prenatally diagnosed portosystemic vascular shunts in clinical outcomes
2023, Andes PediatricaALL THAT PRACTITIONERS SHOULD KNOW ABOUT DUCTUS VENOSUS
2023, Akusherstvo i Ginekologiya (Russian Federation)