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Kidney Week

Abstract: PO1501

Utility of Doppler Ultrasound-Derived Hepatic and Portal Venous Waveforms in the Management of Heart Failure Exacerbation

Session Information

Category: Trainee Case Report

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Singh, Shashank Sharovan, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Ali, Mir tariq, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction

Careful evaluation of the fluid volume status and systemic hemodynamics is of paramount importance in patients with heart failure. With growing interest in point of care ultrasonography, non-invasive parameters such as hepatic and portal vein waveforms are assuming importance as markers of systemic venous congestion.

Case Description

43 year old male was admitted for right lower extremity necrotizing fasciitis requiring below the knee amputation. Postoperatively, he subsequently developed volume overload with pulmonary edema and acute renal injury. Given the patient's sensitive hemodynamic state, volume depletion was driven by doppler ultrasound, specifically portal vein and hepatic vein doppler. After a few days of therapy, the patient had improvement of his renal function, leading to a cessation of dialysis and return of renal function to near baseline.

Discussion

In patients with acute decompensated heart failure, residual clinical congestion at hospital discharge is associated with worse outcomes. A standard assessment of congestion is the measurement of right atrial pressure (RAP) and pulmonary capillary wedge pressures using pulmonary artery catheterization, though its invasive nature precludes routine use. Estimating beside RAP using inferior vena cava (IVC) ultrasound is now common, though it is not without numerous pitfalls limiting its utility. For example, the changes in size of the IVC depend on variations in intrathoracic pressure and lung compliance. Using portal and hepatic vein waveforms can add another piece of information for volume assessment. As shown in our images, the changes initially seen on doppler with hypervolemia can direct management for diuresis/volume removal. These changes seen on doppler waveform aids in management for decongestive therapy.

Portal (A) and Hepatic (B) vein waveforms before decongestive therapy

Portal (A) and Hepatic (B) vein waveforms after decongestive therapy