Comparison of Venous excess ultrasound score and Inferior Vena Cava Collapsibility index in the assessment of venous congestion in Congenital Heart Disease Presenting with Heart Failure

Congenital heart disease (CHD) is the most common congenital anomaly in neonates occurring in 8 per 1,000 births is estimated that there are approximately 250,000 children born with CHD in India every year, CHD is the leading cause of deaths from non-communicable diseases (NCD) in paediatric population CHD deaths in 2019 in the world were 217,000. India, China, Pakistan, and Nigeria had the highest mortality, 39.7% of CHD deaths globally

Congestive heart failure(CHF) occur in CHDs due to hemodynamic change like low cardiac output or increased right atrial filling pressures Increased Right Atrial pressure gets transmitted back to peripheral veins causing congestion of abdominal organs and their dysfunction and thus alterations in organ venous flow quantified using color Doppler Clinical parameters of congestion include dyspnea, orthopnea. Jugular venous distension, edema, fatigue, crackles on auscultation, ascites Failure to thrive, nutritional deficiency, feeding difficulties are common presenting symptoms of congestive HF Persistent growth failure and cardiac dysfunction can also occur

Using Ultrasound, size and collapsibility index of Inferior Vena Cava(VC) determined for assessing Right Atrial Pressure(RAP). However venous congestion is mainly due to transmissions of pressure to peripheral organs. This alters the venous blood flow in portal, hepatic and renal veins which are quantified using Venous Excess Ultrasound Score Normal blood flow in the central veins, including the hepatic veins (HVs), is pulsatile in nature and that in the portal vein and the renal inter lobar vein is continuous or non pulsatile. The VEXUS score is determined first by assessing Inferior vena cava diameter then hepatic venous flow pattern type (S> D-normal, SD<-mild. S wave inversion severe) portal vein Doppler ultrasound to calculate Pulsatility index -Vmax- V min/Vmax 100 (<30% normal, 30-49% mild, >50% severe) and intrarenal flow (continuous-normal, biphasic-mild ,monophasic severe),

Grading of vexus Grade- 0 IVC<2cm- No significant congestion: Grade 1-IVC>2 cm with no hepatic/portal vein abnormality: Grade 2- 1VC-2cm with mild hepatic portal vein abnormality Grade 3- IVC>2cm with severe hepatic portal vein abnormality

This study is to assess venous congestion using Venous Excess Ultrasound in CHD patients presenting with heart failure and thereby help limit fluids in them to avoid organ dysfunction due to congestion .This study may help in preventing over treatment resulting in hypovolemia, Dyselectrolytemia and organ congestion ’VEXUS helps in making major clinical decisions like adjusting the dose of diuretics or inotropes in Heart failure and fluid management in critical phase of dengue fever and malaria VEXUS plays a major role in the prediction and management of Acute Kidney Injury