In Hepatic Veins 101, we discussed the structure, function and waveforms of the hepatic veins, in regards to the cardiac cycle. This blog will cover how the hepatic veins play a role with the right heart. We tend to forget about the importance and useful information the hepatic veins provide us. Lets review, how the hepatic veins play a role in:
The hepatic vein waveform can be reflective on the severity of TR present. The more severe the regurgitation, the more pulsatile the waveform becomes.
Let’s breakdown the waveform process during the cardiac cycle when tricuspid regurgitation is present….
A scale was developed based upon the waveform pattern of the hepatic veins to help with adding more data to assess the severity of TR:
The hepatic vein waveform can also show indications of right heart failure! The change in waveforms are similar to tricuspid regurgitation…
Right Heart Failure Criteria:
In some cases, where the patient has both TR and right heart failure, the hepatic waveforms can become biphasic.
In severe cases, the waveforms can fused into one retrograde wave with an antegrade D-wave.
Items to Note:
A ratio of the velocity-time integrals (VTI’s) of the S-wave and sum of both S-wave and D-wave (the ratio excludes the A-wave).
<55% =RAP > 8 mmHg
By measuring the velocity of the S-wave and D-wave, we can obtain a simple ratio to help indicate if an elevated RAP is present.
Vs/Vd < 1 = Elevated RAP
Let’s take a look at this image below:
Now that we have learned both the basics of hepatic veins and the relativity in regards to the heart, we can now implement evaluation of these veins when indicated during our echocardiograms! Here are a few helpful tips to take away…..
We hope you enjoyed our right heart blog series!
Andrea Fields MHA, RDCS
Scheinfield, M. H., MD, Bilali, A., ARDMS, & Koenigsberg, M., MD. (2009). Understanding the Spectral Doppler Waveform of the Hepatic Veins in Health and Disease. RadioGraphics,29, 2081-2098. Retrieved May 31, 2017, from http://pubs.rsna.org/doi/pdf/10.1148/rg.297095715
Rudski, L. G., MD. (2010). Guidelines for Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. JASE, 23, 685-713.