Abstract
BackgroundPatients 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 presentationPatient 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.ConclusionHepatic 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.
Highlights
Congestive heart failure is a complex condition with effects on other organ systems including liver and kidneys
The aim of this report is to illustrate the clinical utility of portal vein Doppler in assessing venous hypertension, guiding the volume management, and the evolution of the waveforms through two patients with right-sided heart failure
High right-sided filling pressures and tricuspid regurgitation often confound the interpretation of the jugular venous pulse (JVP) rendering it of little clinical utility for volume management [8]
Summary
Congestive heart failure is a complex condition with effects on other organ systems including liver and kidneys. Patients with right heart failure and concurrent illness such as sepsis pose significant challenges in managing volume status for hemodynamic optimization. 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, diuresis was initiated which resulted in portal flow normalization, renal recovery, and cessation of vasopressor support. The patient continued to deteriorate and prior to their death portal vein, Doppler showed significant flow reversal
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