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Updated: Jun 20, 2026
Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Preload index of the inferior vena cava as a possible predictive marker of hydropic changes in fetuses with Ebstein
Nobuhiro Hidaka1, Maiko Sugitani, Yasuyuki Fujita
1Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Higashiku, Fukuoka, Japan. n-hidaka@kpa.biglobe.ne.jp
Insights
The preload index of the inferior vena cava (PLI-IVC) can help predict fetal hydrops in cases of Ebstein anomaly. An increasing PLI-IVC trend indicates cardiac failure, aiding early detection of fetal impairment.
Area of Science:
- Cardiology
- Fetal Medicine
- Medical Imaging
Background:
- Ebstein anomaly is a congenital heart condition affecting the tricuspid valve.
- Fetal hydrops is a serious condition characterized by fluid accumulation in fetal tissues.
- Early prediction of fetal complications in Ebstein anomaly is crucial for management.
Observation:
- The preload index of the inferior vena cava (PLI-IVC) was evaluated in fetuses with prenatally diagnosed Ebstein anomaly.
- PLI-IVC was calculated using reversed right atrial flow velocity and inferior vena cava forward velocity.
- Retrospective review of five cases managed between 1999 and 2008.
Findings:
- All cases with Ebstein anomaly showed a high PLI-IVC.
- An increasing PLI-IVC trend preceded the recognition of hydropic changes in two cases.
- Fetuses without hydrops exhibited a nonlinear PLI-IVC trend without significant increase.
Implications:
- An upward trend in PLI-IVC, rather than a persistently high value, suggests cardiac failure.
- Monitoring IVC blood flow patterns is vital for early identification of fetal impairment in Ebstein anomaly.
- PLI-IVC shows potential as a diagnostic tool for predicting hydropic changes in fetal Ebstein anomaly.
Objective:
We aimed to investigate whether the preload index of the inferior vena cava (PLI-IVC) is of diagnostic value in predicting hydropic changes in fetuses with Ebstein anomaly.
Methods:
Five cases of prenatally diagnosed Ebstein anomaly, which were managed at our institution between 1999 and 2008, were retrospectively reviewed. The PLI-IVC was calculated as the ratio between the reversed flow velocity from the right atrium and the forward velocity of the IVC.
Results:
The PLI-IVC was high in all the cases. In 2 cases, PLI-IVC values tended to increase gradually before hydropic changes were recognized. In the cases without hydrops, PLI-IVC values exhibited a nonlinear trend throughout gestation and did not show any apparent increase.
Conclusions:
The upward trend of the PLI-IVC rather than the maintenance of a high value can be considered a sign of cardiac failure. The blood flow pattern in the IVC should be carefully monitored in fetuses with Ebstein anomaly for the early identification of fetal impairment.
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