Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports
Abstract Background Patients with right heart failure pose significant volume management challenges for hemodynamic optimization. We present two cases in which point of care ultrasound (POCUS) of the hepatic and portal veins contributed to the venous hypertension assessment and decongestive strategy...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2019-11-01
|
| Series: | The Ultrasound Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13089-019-0146-3 |
| _version_ | 1818342600316289024 |
|---|---|
| author | Matthew Jefkins Barry Chan |
| author_facet | Matthew Jefkins Barry Chan |
| author_sort | Matthew Jefkins |
| collection | DOAJ |
| description | Abstract Background Patients with right heart failure pose significant volume management challenges for hemodynamic optimization. We present two cases in which point of care ultrasound (POCUS) of the hepatic and portal veins contributed to the venous hypertension assessment and decongestive strategy for patients with right-sided heart failure. Case presentation Patient A was 91 years old with known pulmonary hypertension and right ventricular systolic dysfunction who presented in septic shock requiring vasopressor support. Hepatic and portal vein Dopplers were consistent with right heart failure and significant venous congestion, therefore, diuresis was initiated which resulted in portal flow normalization, renal recovery, and cessation of vasopressor support. Patient B was 82 years old with severe idiopathic pulmonary fibrosis on home oxygen who presented in decompensated right heart failure. Despite aggressive diuresis, a negative fluid balance was not achieved. The patient continued to deteriorate and prior to their death portal vein, Doppler showed significant flow reversal. Conclusion Hepatic and portal vein Doppler ultrasounds are venous hypertension assessment tools that can be readily used at the bedside by clinicians trained in POCUS that may contribute holistically to the hemodynamic profiling for patients with right heart failure and direct therapeutic interventions. |
| first_indexed | 2024-12-13T16:17:16Z |
| format | Article |
| id | doaj.art-0700e2fc87d048799dc87ec1c12a011b |
| institution | Directory Open Access Journal |
| issn | 2524-8987 |
| language | English |
| last_indexed | 2024-12-13T16:17:16Z |
| publishDate | 2019-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Ultrasound Journal |
| spelling | doaj.art-0700e2fc87d048799dc87ec1c12a011b2022-12-21T23:38:48ZengSpringerOpenThe Ultrasound Journal2524-89872019-11-011111610.1186/s13089-019-0146-3Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reportsMatthew Jefkins0Barry Chan1Division of General Internal Medicine, Department of Medicine, Queen’s UniversityDivision of General Internal Medicine, Department of Medicine, Queen’s UniversityAbstract Background Patients with right heart failure pose significant volume management challenges for hemodynamic optimization. We present two cases in which point of care ultrasound (POCUS) of the hepatic and portal veins contributed to the venous hypertension assessment and decongestive strategy for patients with right-sided heart failure. Case presentation Patient A was 91 years old with known pulmonary hypertension and right ventricular systolic dysfunction who presented in septic shock requiring vasopressor support. Hepatic and portal vein Dopplers were consistent with right heart failure and significant venous congestion, therefore, diuresis was initiated which resulted in portal flow normalization, renal recovery, and cessation of vasopressor support. Patient B was 82 years old with severe idiopathic pulmonary fibrosis on home oxygen who presented in decompensated right heart failure. Despite aggressive diuresis, a negative fluid balance was not achieved. The patient continued to deteriorate and prior to their death portal vein, Doppler showed significant flow reversal. Conclusion Hepatic and portal vein Doppler ultrasounds are venous hypertension assessment tools that can be readily used at the bedside by clinicians trained in POCUS that may contribute holistically to the hemodynamic profiling for patients with right heart failure and direct therapeutic interventions.http://link.springer.com/article/10.1186/s13089-019-0146-3Congestive heart failurePoint of care ultrasoundPortal veinDoppler |
| spellingShingle | Matthew Jefkins Barry Chan Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports The Ultrasound Journal Congestive heart failure Point of care ultrasound Portal vein Doppler |
| title | Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports |
| title_full | Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports |
| title_fullStr | Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports |
| title_full_unstemmed | Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports |
| title_short | Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports |
| title_sort | hepatic and portal vein dopplers in the clinical management of patients with right sided heart failure two case reports |
| topic | Congestive heart failure Point of care ultrasound Portal vein Doppler |
| url | http://link.springer.com/article/10.1186/s13089-019-0146-3 |
| work_keys_str_mv | AT matthewjefkins hepaticandportalveindopplersintheclinicalmanagementofpatientswithrightsidedheartfailuretwocasereports AT barrychan hepaticandportalveindopplersintheclinicalmanagementofpatientswithrightsidedheartfailuretwocasereports |