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Normal patterns of flow in the superior caval, hepatic and pulmonary veins as measured using Doppler echocardiography during childhood

  • Canan Ayabakan (a1) and Süheyla Özkutlu (a1)


To date, no reference values have been provided for right and left atrial filling in normal children. The aim of our study, therefore, was to characterize measurements of superior caval, hepatic, and pulmonary venous flow using Doppler echocardiography in a large group of normal children to reflect the effects of age, body mass index, sex, heart rate and respiration.

Doppler echocardiographic examinations of the superior caval, hepatic and pulmonary veins were performed during inspiration and expiration in 72 healthy children with a mean age of 6.73 ± 5.10 years. The subjects were segregated into four age groups, namely infants <2 years, preschool children between the ages of 2 and 7 years, children of school age between 7 and 11 years, and adolescents older than 11 years.

Age has significant effect on the systolic and reverse atrial flows within the superior caval vein (p < 0.05). No change in the Doppler velocities was observed related to body mass index or sex. All peak systolic velocities decreased significantly during expiration (p < 0.05). This decrease was most prominent in the hepatic vein (26%), but less remarkable in the superior caval vein (5.7%) and the pulmonary veins (3.9%). During expiration, the peak diastolic flow in the superior caval and the hepatic veins decreased, while the reverse atrial flow in the hepatic vein increased (p < 0.05). Pulmonary venous velocities were similar in all age groups (p > 0.05). Except for the systolic pulmonary venous velocities, these parameters were not influenced by respiration (p > 0.05). The diastolic time, the interval between reverse atrial flow and ventricular systole reflected by the R wave on the electrocardiogram, and the interval between ventricular systole and diastolic flow, were negatively correlated with heart rate (p < 0.05; r = −0.35, −0.85, and −0.8 respectively), and positively correlated with age (p < 0.05; r = 0.3, 0.8, and 0.7 respectively). They were not influenced by respiration.

Our study provides data of the patterns and the normal ranges of velocities of superior caval, hepatic, and pulmonary venous flow in a series of normal children. The results can now be used for comparison with the patterns found in the setting of disease.


Corresponding author

Correspondence to: Canan Ayabakan, MD, Acibadem cad. Gomec sok. No: 27 A/11, 34718 Kadikoy, Istanbul, Turkey. Tel: +90(216) 325 70 65; Fax: +90(216) 325 12 59; E-mail:


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Ghio S, Recusani F, Sebastiani R, et al. Doppler velocimetry in superior vena cava provides useful information on the right circulatory function in patients with congestive heart failure. Echocardiography 2001; 18: 469477.
Byrd BF, Linden RW. Superior vena cava Doppler flow velocity patterns in pericardial disease. Am J Cardiol 1990; 65: 14641470.
Zhang-An, Himura Y, Kumada T, et al. The characteristics of hepatic venous flow velocity pattern in patients with pulmonary hypertension by pulsed Doppler echocardiography. Jpn Circ J 1992; 56: 317324.
Wranne B, Pinto FJ, Hammarstrom E, St Goar FG, Puryear J, Popp RL. Abnormal right heart filling after cardiac surgery: time course and mechanism. Br Heart J 1991; 66: 435442.
Oki T, Iuchi A, Tabata T, et al. Transesophageal pulsed Doppler echocardiographic study of systolic flow velocity patterns of the pulmonary vein in patients with atrial fibrillation. Echocardiography 1998; 15: 147156.
Vitarelli A, Luzzi MF, Penco M, Ciciarello F, Fedele F, Dagianti A. PVF velocity pattern in patients with heart failure: transesophageal echocardiographic assessment. Cardiology 1997; 88: 585594.
O'Leary PW, Durongpisitkul K, Cordes TM, et al. Diastolic ventricular function in children: a Doppler echocardiographic study establishing normal values and predictors of increased ventricular end-diastolic pressure. Mayo Clin Proc 1998; 73: 616628.
Jequier S, Jequier JC, Hanquinet S, Le Coultre C, Belli DC. Hepatic vein Doppler studies: variability of flow pattern in normal children. Pediatr Radiol 2002; 32: 4955.
Jequier S, Jequier JC, Hanquinet S, Gong J, Le Coultre C, Belli DC. Doppler waveform of hepatic veins in healthy children. Am J Roentgenol 2000; 175: 8590.
Meyer RJ, Goldberg SJ, Donnerstein RL. Superior vena cava and hepatic vein velocity patterns in normal children. Am J Cardiol 1993; 72: 238240.
Klein AL, Leung DY, Murray RD, Urban LH, Bailey KR, Tajik AJ. Effects of age and physiologic variables on right ventricular filling dynamics in normal subjects. Am J Cardiol 1999; 84: 440448.
Gindea AJ, Slater J, Kronzon I. Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects. Am J Cardiol 1990; 65: 13871391.
Cohen ML, Cohen BS, Kronzon I, Lightly GW, Winer HE. Superior vena caval blood flow velocities in adults: a Doppler echocardiographic study. J Appl Physiol 1986; 61: 215219.
Shapiro RS, Winsberg F, Maldjian C, Stancato-Pasik A. Variability of hepatic vein Doppler tracings in normal subjects. J Ultrasound Med 1993; 12: 701703.
Abu-Yousef MM. Normal and respiratory variations of the hepatic and portal venous duplex Doppler waveforms with simultaneous electrocardiographic correlation. J Ultrasound Med 1992; 11: 263268.
Coulden RA, Lomas DJ, Farman P, Britton PD. Doppler ultrasound of the hepatic veins: normal appearances. Clin Radiol 1992; 45: 223227.
Appleton CP, Hatle LK, Popp RL. Superior vena cava and hepatic vein Doppler echocardiography in healthy adults. J Am Cardiol 1987; 10: 10321039.
De Marchi SF, Boldenmuller M, Lai DL, Seiler C. Pulmonary venous flow velocity patterns in 404 individuals without cardiovascular disease. Heart 2001; 85: 2329.
Klein AL, Abdulla I, Murray RD, et al. Age independence of the difference in duration of pulmonary venous atrial reversal flow and transmitral A-wave flow in normal subjects. J Am Soc Echocardiogr 1998; 11: 458465.
Gentile F, Mantero A, Lippolis A, et al. Pulmonary venous flow velocity patterns in 143 normal subjects aged 20 to 80 years old. An echo 2D colour Doppler cooperative study. Eur Heart J 1997; 18: 148164.
Salim MA, DiSessa TG, Arheart KL, Alpert BS. Contribution of superior vena caval flow to cardiac output in children. Circulation 1995; 92: 18601865.
Riggs TW, Snider R. Respiratory influence on right and left ventricular diastolic function in normal children. Am J Cardiol 1989; 63: 858861.
Eckner FAO, Brown WB, Davidson DL, Glagov S. Dimensions of normal human hearts. Arch Pathol 1969; 88: 497507.
Kuecherer HF, Muhiudeen IA, Kusumoto FM, et al. Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 1990; 82: 11271139.
Zoghbi WA, Habib GB, Quinones MA. Doppler assessment of right ventricular filling in normal population. Comparison with left ventricular filling dynamics. Circulation 1990; 82: 13161324.
Hsia TY, Khambadkone S, Deanfield JE, Taylor JF, Migliavacca F, de Leval MR. Subdiaphragmatic venous hemodynamics in the Fontan circulation. J Thorac Cardiovasc Surg 2001; 121: 436447.
Hsia TY, Khambadkone S, Redington AN, Migliavacca F, Deanfield JE, de Leval MR. Effects of respiration and gravity on infradiaphragmatic venous flow in normal and Fontan patients. Circulation 2000; 102 (19 Suppl 3): III: 148153.
Kaulitz R, Bergman P, Luhmer I, Paul T, Hausdorf G. Instantaneous pressure-flow velocity relations of systemic venous return in patients with univentricular circulation. Heart 1999; 82: 294299.
Kaulitz R, Luhmer I, Kallfelz HC. Pulsed Doppler echocardiographic assessment of patterns of venous flow after the modified Fontan operation: potential clinical implications. Cardiol Young 1998; 8: 5462.


Normal patterns of flow in the superior caval, hepatic and pulmonary veins as measured using Doppler echocardiography during childhood

  • Canan Ayabakan (a1) and Süheyla Özkutlu (a1)


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