Introduction: Hepatic venous flow patterns reflect pressure changes in the right ventricle
and are also markers of systemic venous congestion. Fluid management is crucial in
patients undergoing cardiac surgery. Methods: Our goal was to determine which factors
are associated with the increased congestion of the liver as measured by Doppler ultrasound
in patients undergoing cardiac surgery. This prospective, observational study included
41 patients without preexisting liver disease who underwent cardiac surgery between
1 January 2021 and 30 September 2021 at a tertiary heart center. In addition to routine
echocardiographic examination, we recorded the maximal velocity and velocity time
integral (VTI) of the standard four waves seen in the common hepatic vein (flow profile)
using Doppler ultrasound preoperatively and at the 20–24th hour of the postoperative
period. The ratios of the retrograde and anterograde hepatic venous waves were calculated,
and the waveforms were compared to the baseline value and expressed as a delta ratio.
Demographic data, pre- and postoperative echocardiographic parameters, intraoperative
variables (procedure, cardiopulmonary bypass time), postoperative factors (fluid balance,
vasoactive medication requirement, ventilation time and parameters) and perioperative
laboratory parameters (liver and kidney function tests, albumin) were used in the
analysis. Results: Of the 41 patients, 20 (48.7%) were males, and the median age of
the patients was 65.9 years (IQR: 59.8–69.9 years). Retrograde VTI growth showed a
correlation with positive fluid balance (0.89 (95% CI 0.785–0.995) c-index. After
comparing the postoperative echocardiographic parameters of the two subgroups, right
ventricular and atrial diameters were significantly greater in the “retrograde VTI
growth” group. The ejection fraction and decrement in ejection fraction to preoperative
parameters were significantly different between the two groups. (p = 0.001 and 0.003).
Ventilation times were longer in the retrograde VTI group. The postoperative vs. baseline
delta VTI ratio of the hepatic vein correlated with positive fluid balance, maximum
central venous pressure, and ejection fraction. (B = −0.099, 95% CI = −0.022–0.002,
p = 0.022, B = 0.011, 95% CI = 0.001–0.021, p = 0.022, B = 0.091, 95% CI = 0.052–0.213,
p = 0.002, respectively.) Conclusion: The increase of the retrograde hepatic flow
during the first 24 h following cardiac surgery was associated with positive fluid
balance and the decrease of the right ventricular function. Measurement of venous
congestion or venous abdominal insufficiency seems to be a useful tool in guiding
fluid therapy and hemodynamic management.
