This is the case of an 86-year-old man admitted to the ICU due to right-sided heart failure (RSHF) after Mitraclip® implantation, severe chronic pulmonary hypertension, acute kidney injury, and elevated levels of transaminase and bilirubin. The VExUS (Venous Excess Ultrasound Score) system was used. Fig. 1 shows flow reversal during ventricular systole on the Doppler echocardiography of suprahepatic veins (red arrows). Fig. 2 shows the monophasic renal interlobar venous Doppler flow pattern (lack of venous flow [blue arrows] in systole [white arrows]). Both findings are suggestive of severe systemic venous congestion (SVC). However, portal vein Doppler (PVD) (Fig. 3) was not pulsatile (as it would have been expected in SVC). Cirrhosis-induced portal fibrosis (due to RSHF) prevents the transmission of pulsatility across venous flow being PVD, in this case, not assessable with the VExUS to diagnose SVC due to being a false negative outcome.
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The VExUS (Venous Excess Ultrasound Score) system was used. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows flow reversal during ventricular systole on the Doppler echocardiography of suprahepatic veins (red arrows). <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the monophasic renal interlobar venous Doppler flow pattern (lack of venous flow [blue arrows] in systole [white arrows]). Both findings are suggestive of severe systemic venous congestion (SVC). However, portal vein Doppler (PVD) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) was not pulsatile (as it would have been expected in SVC). Cirrhosis-induced portal fibrosis (due to RSHF) prevents the transmission of pulsatility across venous flow being PVD, in this case, not assessable with the VExUS to diagnose SVC due to being a false negative outcome.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1672 "Ancho" => 2515 "Tamanyo" => 337111 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1716 "Ancho" => 2628 "Tamanyo" => 382254 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1640 "Ancho" => 2628 "Tamanyo" => 270632 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004700000007/v1_202306271042/S2173572722003034/v1_202306271042/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004700000007/v1_202306271042/S2173572722003034/v1_202306271042/en/main.pdf?idApp=WMIE&text.app=https://www.medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722003034?idApp=WMIE" ]