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ASSESSMENT OF THE MATERNAL VENOUS CIRCULATION: WHY IS IT RELEVANT?

  • KATHLEEN TOMSIN (a1) and WILFRIED GYSELAERS (a2)

Extract

The venous system is considered the main capacitor of the human body. Approximately 70% of the total blood volume resides in the venous bed, half of which circulates as venous return whereas the other half functions as reserve volume in the splanchnic veins. These veins are richly innervated and highly compliant, and communicate with the systemic circulation via capillaries (entrance) and portal vein and liver (exit). This constitution allows the venous compartment to balance circulating and stored blood volumes, and thus control cardiac output. Clinical conditions with reduced cardiac output are often associated with hampered venous return, resulting in visceral oedema, ascites or organ dysfunction. Organ dysfunction or failure may also result from (sub)obstructed venous outflow, as is illustrated in renal vein thrombosis or in the Nutcracker syndrome. Recently, the application of Doppler ultrasonography in the study of the maternal venous system illustrated that preeclampsia is another cardiovascular disorder with dysfunctional venous haemodynamics. In this opinion paper, we summarise results from Doppler studies of the maternal venous compartment, illustrating that performing venous haemodynamics function tests is to become a fundamental part of an integrated cardiovascular assessment of women with hypertension in pregnancy, facilitating an individualised diagnostic and therapeutic approach for every woman at risk for gestational hypertensive disease.

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Corresponding author

Kathleen Tomsin, MSc, PhD, Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium. Email: kathleen.tomsin@gmail.com

References

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1Gelman, S. Venous function and central venous pressure: a physiologic story. Anesthesiology 2008; 108: 735–48.
2Malbrain, ML, Deeren, D, De Potter, TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005; 11: 156–71.
3Asghar, M, Ahmed, K, Shah, SS, Siddique, MK, Dasgupta, P, Khan, MS. Renal vein thrombosis. Eur J Vasc Endovasc Surg 2007; 34: 217–23.
4Ozcakar, ZB, Yalcinkaya, F, Fitoz, S, Cipe, G, Soygur, T, Ozdemir, H, et al.Nutcracker syndrome manifesting with severe proteinuria: a challenging scenario in a single-kidney patient. Pediatr Nephrol 2011; 26: 987–90.
5Boulpaep, EL. Regulation of arterial pressure and cardiac output. In: Boron, WF, Boulpaep, EL (eds.). Medical physiology. Philadelphia, PA: Elsevier, 2003; 534–57.
6Pedersen, JF, Dakhil, AZ, Jensen, DB, Sondergaard, B, Bytzer, P. Abnormal hepatic vein Doppler waveform in patients without liver disease. Br J Radiol 2005; 78: 242–4.
7Duvekot, JJ, Cheriex, EC, Pieters, FA, Menheere, PP, Peeters, LH. Early pregnancy changes in hemodynamics and volume homeostasis are consecutive adjustments triggered by a primary fall in systemic vascular tone. Am J Obstet Gynecol 1993; 169: 1382–92.
8Carbillon, L, Uzan, M, Uzan, S. Pregnancy, vascular tone, and maternal hemodynamics: a crucial adaptation. Obstet Gynecol Surv 2000; 55: 574–81.
9Duvekot, JJ, Peeters, LL. Renal hemodynamics and volume homeostasis in pregnancy. Obstet Gynecol Surv 1994; 49: 830–9.
10Gyselaers, W, Molenberghs, G, Van Mieghem, W, Ombelet, W. Doppler measurement of renal interlobar vein impedance index in uncomplicated and preeclamptic pregnancies. Hypertens Pregnancy 2009; 28: 2333.
11Gyselaers, W, Mesens, T, Tomsin, K, Peeters, L. Doppler assessment of maternal central venous hemodynamics in uncomplicated pregnancy: a comprehensive review. Facts, Views Visions Obstet Gynaecol 2009; 1: 171–81.
12Tomsin, K, Vriens, A, Mesens, T, Gyselaers, W. Non-invasive cardiovascular profiling using combined electrocardiogram-Doppler ultrasonography and impedance cardiography: an experimental approach. Clin Exp Pharmacol Physiol 2013; 40: 438–42.
13Ohta, M, Hashizume, M, Tomikawa, M, Ueno, K, Tanoue, K, Sugimachi, K. Analysis of hepatic vein waveform by Doppler ultrasonography in 100 patients with portal hypertension. Am J Gastroenterol 1994; 89: 170–5.
14Tomsin, K, Mesens, T, Molenberghs, G, Gyselaers, W. Venous pulse transit time in normal pregnancy and preeclampsia. Reprod Sci 2012; 19: 431–6.
15Tomsin, K, Mesens, T, Molenberghs, G, Peeters, L, Gyselaers, W. Time interval between maternal electrocardiogram and venous Doppler waves in normal pregnancy and preeclampsia: a pilot study. Ultraschall Med 2012; 33: E11925.
16Bernstein, IM, Meyer, MC, Osol, G, Ward, K. Intolerance to volume expansion: a theorized mechanism for the development of preeclampsia. Obstet Gynecology 1998; 92: 306–8.
17Easterling, TR, Benedetti, TJ, Carlson, KC, Brateng, DA, Wilson, J, Schmucker, BS. The effect of maternal hemodynamics on fetal growth in hypertensive pregnancies. Am J Obstet Gynecol 1991; 165: 902–6.
18Tomsin, K, Mesens, T, Molenberghs, G, Peeters, L, Gyselaers, W. Characteristics of heart, arteries, and veins in low and high cardiac output preeclampsia. Eur J Obstet Gynecol Reprod Biol 2013; 169: 218–22.
19Valensise, H, Vasapollo, B, Gagliardi, G, Novelli, GP. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension 2008; 52: 873–80.
20Gyselaers, W, Mesens, T, Tomsin, K, Molenberghs, G, Peeters, L. Maternal renal interlobar vein impedance index is higher in early- than in late-onset pre-eclampsia. Ultrasound Obstet Gynecol 2010; 36: 6975.

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