- Infracardiac TAPVR
- Descending vertical vein seen draining inferiorly and into the portal vein/ductus venosus
- As vertical vein enters the portal vein/ductus venosus the flow becomes turbulent consistent with pulmonary venous obstruction
- Infracardiac TAPVR
- Descending vertical vein seen draining inferiorly and into the portal vein/ductus venosus
- As vertical vein enters the portal vein/ductus venosus, the flow becomes turbulent consistent with pulmonary venous obstruction
- Infracardiac TAPVR
- Descending vertical vein seen draining inferiorly and into the portal vein/ductus venosus
- As vertical vein enters portal vein/ductus venosus, the flow becomes turbulent consistent with pulmonary venous obstruction
- Infracardiac TAPVR
- Spectral Doppler in descending vertical vein revealing stenosis at the site of insertion of the vertical vein into the portal vein/ductus venosus
- Loss of normal phasicity and abnormal Doppler pattern consistent with obstructed pulmonary venous return (mean gradient of 10 mmHg)
Echocardiographic Assessment: Subcostal short axis IVC
- Vertical vein anatomy and course
- Good for profiling the full course of the descending vertical vein as it travels inferiorly below the diaphragm
- Assess by color and spectral Doppler for evidence of turbulence/obstruction along its course or insertion
- most commonly as the vertical vein descends below the diaphram and enters the portal venous circulation
- Inferior vena cava/portal vein/ductus venosus
- Size and flow by 2D, color and spectral Doppler
- Assess for connection to vertical vein
- Assess for obstruction as vertical vein connects to portal venous circulation by 2D, color and spectral Doppler
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- Transducer on abdomen just below xyphoid process
- Notch at 6 o'clock
- Probe tilted towards patient's right shoulder