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. 2015 Jan;34(1):32-8.
doi: 10.14366/usg.14029. Epub 2014 Aug 27.

Doppler ultrasonography measurement of hepatic hemodynamics during Valsalva maneuver: healthy volunteer study

Dong-Ho Bang  1 , Youngjun Son  1 , Young Hwan Lee  1 , Kwon-Ha Yoon  1
Affiliations

Doppler ultrasonography measurement of hepatic hemodynamics during Valsalva maneuver: healthy volunteer study

Dong-Ho Bang et al. Ultrasonography. 2015 Jan.

Abstract

Purpose: The aim of our study was to assess the hemodynamic change of liver during the Valsalva maneuver using Doppler ultrasonography.

Methods: Thirty healthy men volunteers were enrolled (mean age, 25.5±3.64 years). The diameter, minimal and maximal velocities, and volume flow of intrahepatic inferior vena cava (IVC), middle hepatic vein (MHV), and right main portal vein (RMPV) was measured during both rest and Valsalva maneuver. These changes were compared using paired t-test.

Results: The mean diameters (cm) of the intrahepatic IVC at rest and Valsalva maneuver were 1.94±0.40 versus 0.56±0.66 (P<0.001). The mean diameter (cm), minimal velocity (cm/sec), maximal velocity (cm/sec), and volume flow (mL/min) of MHV at rest and Valsalva maneuver were 0.60±0.15 versus 0.38±0.20 (P<0.001), -7.98±5.47 versus 25.74±13.13 (P<0.001), 21.34±6.89 versus 35.12±19.95 (P=0.002), and 106.94±97.65 versus 153.90±151.80 (P=0.014), respectively. Those of RMPV at rest and Valsalva maneuver were 0.78±0.21 versus 0.76±0.20 (P=0.485), 20.21±8.22 versus 18.73±7.43 (P=0.351), 26.79±8.85 versus 24.93±9.91 (P=0.275), and 391.52±265.63 versus 378.43±239.36 (P=0.315), respectively.

Conclusion: The blood flow velocity and volume flow of MHV increased significantly during Valsalva maneuver. These findings suggest that hepatic vein might play an important role to maintain venous return to the heart during the maneuver.

Keywords: Hemodynamics; Hepatic veins; Liver; Ultrasonography, Doppler; Valsalva maneuver.

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Conflict of interest statement

No potential conflict of interest relevant to this article was repoted.

Figures

Fig. 1.
Fig. 1.. Doppler wave form changes of middle hepatic vein with monophasic pattern during the Valsalva maneuver.
A. The waveform is biphasic pattern at rest. B. During the Valsalva maneuver, the middle hepatic vein’s waveform express decreased in diameter, increased in minimal and maximal velocities, and its waveform change to a monophasic pattern.
Fig. 2.
Fig. 2.. Doppler wave form change of middle hepatic vein to biphasic pattern with elevated baseline during the Valsalva maneuver.
A. At rest, biphasic pattern is seen in a subject. B. During Valsalva maneuver, baseline is elevated and peak velocity is maintained. This peak velocity was thought as a dominant antegrade wave caused by suction of blood into the right atrium from the liver due to the tricuspid annulus which moves toward the cardiac apex during ventricular systole.
Fig. 3.
Fig. 3.. Doppler wave form of middle hepatic vein with biphasic pattern without significant change during Valsalva maneuver.
A. At rest, biphasic pattern is seen in a subject. B. During Valsalva maneuver, there is no significant change of the waveform’s morphology and its diameter; there is no elevation of minimal velocity or maximal velocity.
See this image and copyright information in PMC

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