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Journal of Ultrasound in Medicine, Vol 11, Issue 6 263-268, Copyright © 1992 by American Institute of Ultrasound in Medicine
Normal and respiratory variations of the hepatic and portal venous duplex Doppler waveforms with simultaneous electrocardiographic correlation
M. M. Abu-Yousef
Department of Radiology, University of Iowa College of Medicine, Iowa City.
To understand hepatic vein (HV) and portal vein (PV) duplex waveforms and
their normal and respiratory variations, HV and PV duplex sonography with
simultaneous electrocardiography was performed on 11 volunteers. Absolute
velocities of the waveforms' components and their ratios were determined at
mid-inspiration, full inspiration, full expiration, and Valsalva maneuver.
The normal HV waveform was variable in shape and component velocities and
ratios but essentially consisted sequentially of (1) an antegrade systolic
wave resulting from movement of the tricuspid annulus toward the cardiac
apex and occurring shortly after QRS; (2) a retrograde v-wave resulting
from atrial overfilling and occurring immediately after the T-wave; (3) an
antegrade diastolic wave resulting from opening of the tricuspid valve and
occurring shortly after the T-wave; and (4) a retrograde a-wave resulting
from atrial contraction and occurring immediately after the P-wave. The
ratio of the maximum systolic velocity to maximum diastolic velocity varied
from 1.0 to 2.8 (mean 1.4). Systolic-to-diastolic ratio decreased during
inspiration but was always greater than 0.6 and increased during
expiration. The Valsalva maneuver diminished waveform pulsatility. PV
waveforms were more triphasic than biphasic but less pulsatile, flow was
totally antegrade, and respiratory changes were less remarkable than HV
waveforms. All normal HV and most normal PV waveforms showed multiphasicity
that corresponded to cyclic cardiac changes. The shapes of these waveforms
were variable and were modified by respiratory movements.
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