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Haemodynamics / Flow dynamics, Instrumentation, Ultrasound, Vascular
M. Laganà1, M. Di Rienzo2, F. Rizzo2, L. Forzoni3, S. D'Onofrio3, P. Cecconi4; 1Milan/IT, 2Milano/IT, 3Firenze/IT, 4Como (CO)/IT
Aims and objectives
It is well known from physiology that respiration,
besides heart beating,
influences the venous return ,
but there is not a non-invasive study about how much the heart pulsation and the breathing amplitude and phase affect the venous flow.
The breathing control,
during an investigation of the neck and head venous return,
especially when the examined subject is lying supine,
because the breath influences the vessel dimension and the kind and amount of flow.
For the examination of venous behavior under different conditions,
a sonographer can ask a subject to engage in various respiratory activities (e.g.
relaxed or deep respiration,
The correspondence between a particular respiratory phase and the current echographic image (morphological or hemodynamic) is possible because Ultrasound (US) is a real-time examination and the sonographer observes the subject's respiration.
the matching is not exact and when an exam is subsequently reviewed,
it is difficult,
if not impossible,
to know the kind of breathing pattern corresponding to a specific image and consequently to realize if a particular morphology or blood flow are due to a maneuver,
or to subject movement or to abnormal breathing.
The examination of the neck and head veins with US has recently gained particular attention,
for its application in the study of subjects with chronic cerebrospinal venous insufficiency [2,
transient global amnesia ,
exertional  and cough headache ,
idiopathic intracranial hypertension  and transient monocular blindness .
The cervical veins most commonly examined with US for the study of these pathologies are the Internal Jugular Vein (IJV) and the Vertebral Vein (VV) [2,
As regards the cerebral district,
the Basal Vein of Rosenthal (BVR) is the most commonly evaluated one .
Neck venous US examination consists of a real-time investigation of various morphological,
functional and hemodynamic characteristics,
such as vein walls,
valve and blood flow.
the vein walls are studied in terms of dimension and shape along the whole vessel and in different body positions (supine and erect); the valves are investigated for their morphology and mobility and the blood flow velocity is measured in different conditions and in distinct vessel points,
along longitudinal or transverse axes.
studying these characteristics during regular breathing,
it is sometimes needed to look at how a vessel responds to specific maneuvers,
which can reveal valve incompetence or vessel lumen changes.
The effect of deep breathing  or breath-holding  or particular maneuvers like Valsalva [5,
13] or modified Valsalva (i.e.
expiration instead of inspiration)  is investigated in clinical routine and in research protocols,
regarding physiologic or pathologic conditions in different districts,
like neck [5,
head  and lower limbs .
In the present work we evaluated the feasibility of a new measurement setting for the neck and head venous US examination with the real-time recording of breathing and Electrocardiogram (ECG),
all simultaneously displayed on the US screen.