Absent ductus venosus

Last revised by Yusra Sheikh on 4 Nov 2021

Agenesis of the ductus venosus (ADV) is a rare fetal vascular anomaly.

According to the data obtained from the screening tests performed at 11-14 weeks of pregnancy, its incidence is reported to be 1/2500 12.

In a large case series, Acherman et al. 13 defined five drainage patterns in absent ductus venosus:

  • the umbilical vein is connected to the systemic venous circulation through the portal sinus
    • via an abnormal venous channel from the portal sinus to the right atrium 
    • presumably via hepatic sinusoids to the hepatic veins
  • the umbilical vein bypasses the portal sinus and the liver and connects to the systemic venous circulation via an abnormal venous channel (case 2)
    • from the umbilical vein to the right atrium, directly or through a dilated coronary sinus: considered the most common type 5 and carries the worst prognosis due to the risk of developing congestive cardiac failure 11
    • from the umbilical vein to the midportion of the inferior vena cava (IVC)
  • from the umbilical vein to the right iliac vein (case 1)

The prognosis of fetuses with absent ductus venosus diagnosed at 11-13 weeks of gestation depends on the measurement of nuchal translucency thickness, being poor if the thickness is increased and good if it is normal 12.

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