title: Internal jugular vein valve incompetence in COPD and primary pulmonary hypertension.
abstract: OBJECTIVE
  Under physiologic conditions, intact internal jugular vein valves (IJVVs) efficiently prevent retrograde venous flow during intrathoracic pressure increase. Chronically elevated central venous pressure found in patients with chronic obstructive pulmonary disease (COPD) and primary pulmonary hypertension (PPH) might lead to IJVV incompetence (IJVVI). The aim of this study was to analyze the prevalence of IJVVI in patients with COPD and PPH using duplex sonography (DUS).
  
  
  METHODS
  We included 30 COPD patients, 5 PPH patients, and 100 healthy controls in the study. IJVVI was diagnosed if retrograde jugular blood flow was seen on DUS during a Valsalva maneuver. Retrograde venous flow intensity was evaluated and graded according to extent and duration of reflux.
  
  
  RESULTS
  IJVVI was found in 18 (60%) COPD patients and in all 5 (100%) PPH patients, which was significantly different from the controls (27%; p < 0.005). The intensity of venous retrograde flow correlated with the pulmonary artery pressure.
  
  
  CONCLUSIONS
  Compared with healthy controls, COPDand PPH patients demonstrated a significantlygreater prevalence of IJVVI, which seems to be caused by the elevated central venous pressure. These patients may be at higher risk to develop central nervous system diseases related to cerebral outflow obstruction.
authors.affiliation: Department of Neurology, University Hospital Charité, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Doepp
authors.forename: Dieter
authors.initials: D
authors.lastname: Bähr
authors.forename: Matthias
authors.initials: M
authors.lastname: John
authors.forename: Sören
authors.initials: S
authors.lastname: Hoernig
authors.forename: José M
authors.initials: JM
authors.lastname: Valdueza
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018615:Ultrasonography, Doppler, Color; D014636:Valsalva Maneuver; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*