Aortic Vorticity, Helicity, and Aortopathy in Adult Patients with Tetralogy of Fallot: Pilot Study Using Four-Dimensional Flow Magnetic Resonance Images

Shiina, Yumi; Inai, Kei; Miyazaki, Shohei; Nagao, Michinobu

doi:10.1007/s00246-020-02466-0

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…Flow visualization of the MPA and quantification of circulation, which is an area integral of vorticity, were performed using 4D flow postprocessor software (iT Flow; Cardioflow Design. Inc., Tokyo, Japan) 11 , 12 . The magnitude of 4D-flow MRI and 4D-flow MR phase-specific images was used for anatomical segmentation of the pulmonary artery.…”

Section: Methodsmentioning

confidence: 99%

Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

Tsuchiya

Nagao

Shiina

et al. 2021

Sci Rep

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We used 4D-flow MRI to investigate circulation, an area integral of vorticity, in the main pulmonary artery (MPA) as a new hemodynamic parameter for assessing patients with a repaired Tetralogy of Fallot (TOF). We evaluated the relationship between circulation, right ventricular (RV) function and the pulmonary regurgitant fraction (PRF). Twenty patients with a repaired TOF underwent cardiac MRI. Flow-sensitive 3D-gradient sequences were used to obtain 4D-flow images. Vortex formation in the MPA was visualized, with short-axis and longitudinal vorticities calculated by software specialized for 4D flow. The RV indexed end-diastolic/end-systolic volumes (RVEDVi/RVESVi) and RV ejection fraction (RVEF) were measured by cine MRI. The PR fraction (PRF) and MPA area were measured by 2D phase-contrast MRI. Spearman ρ values were determined to assess the relationships between circulation, RV function, and PRF. Vortex formation in the MPA occurred in 15 of 20 patients (75%). The longitudinal circulation (11.7 ± 5.1 m2/s) was correlated with the RVEF (ρ = − 0.85, p = 0.0002), RVEDVi (ρ = 0.62, p = 0.03), and RVESVi (ρ = 0.76, p = 0.003) after adjusting for the MPA size. The short-axis circulation (9.4 ± 3.4 m2/s) in the proximal MPA was positively correlated with the MPA area (ρ = 0.61, p = 0.004). The relationships between the PRF and circulation or RV function were not significant. Increased longitudinal circulation in the MPA, as demonstrated by circulation analysis using 4D flow MRI, was related to RV dysfunction in patients with a repaired TOF.

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Section: Methodsmentioning

confidence: 99%

Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

Tsuchiya

Nagao

Shiina

et al. 2021

Sci Rep

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“…Overloaded volume through the aorta caused by flow shunting and PA hypoplasia, together with abnormal aortic geometry characterized by overriding and a misaligned dextrorotated aortic root, may generate abnormal pressure and shear stress, which could stimulate aortic remodeling. Increased aortic wall shear stress (WSS) has been identified in patients with ToF using four-dimensional flow magnetic resonance imaging 16,17 . In the bicuspid AV, which shares similar clinical (aortic dilation) and histological (medial degradation) features with ToF, increased WSS was associated with regional elastin fiber thinning 18 and higher concentrations of transforming growth factor beta-1 (TGF-β1) and matrix metalloproteinases (MMPs) alongside decreased concentrations of MMP inhibitors in aortic tissue 19 .…”

Section: Discussionmentioning

confidence: 99%

Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

Zhou

Liu

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work? Using the velocity vector imaging speckle-tracking technique, this work revealed reduced measures of ascending aortic elasticity (mean longitudinal strain, global circumferential strain and fractional area change) in fetuses with tetralogy of Fallot (ToF), associated with neonatal aortic annular dilation. What are the clinical implications of this work?Impaired ascending aortic elasticity in the fetal period predicts neonatal aortic annular dilation. The predictive value of reduced measures of ascending aortic elasticity with respect to long-term aortic disease or aorta-related cardiovascular outcomes for patients with ToF is uncertain and should be the subject of further research.

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“…Adult congenital heart disease (ACHD) patients often have dilated aortic roots with anatomical malalignment of the root structure, and helical spiral flow is reported to have been observed in the aortic root, such as the overriding of the aortic root in the tetralogy of Fallot. 35 Fig. 5 (unpublished data) describes ACHD samples with highly cross-linked vortex filaments in the aortic root compared with the healthy normal spiral aortic root flow pattern with a well-aligned vortex filaments with small Helicity.…”

Section: Parameters To Evaluate Vortical and Helical Flowmentioning

confidence: 99%

Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications

Sekine

Yamagishi

Maeda

et al. 2022

MRMS

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Blood flow imaging becomes an emerging trend in cardiology with the recent progress in computer technology. It not only visualizes colorful flow velocity streamlines but also quantifies the mechanical stress on cardiovascular structures; thus, it can provide the detailed inspections of the pathophysiology of diseases and predict the prognosis of cardiovascular functions. Clinical applications include the comprehensive assessment of hemodynamics and cardiac functions in echocardiography vector flow mapping (VFM), 4D flow MRI, and surgical planning as a simulation medicine in computational fluid dynamics (CFD).For evaluation of the hemodynamics, novel mathematically derived parameters obtained using measured velocity distributions are essential. Among them, the traditional and typical parameters are wall shear stress (WSS) and its related parameters. These parameters indicate the mechanical damages to endothelial cells, resulting in degenerative intimal change in vascular diseases. Apart from WSS, there are abundant parameters that describe the strength of the vortical and/or helical flow patterns. For instance, vorticity, enstrophy, and circulation indicate the rotating flow strength or power of 2D vortical flows. In addition, helicity, which is defined as the cross-linking number of the vortex filaments, indicates the 3D helical flow strength and adequately describes the turbulent flow in the aortic root in cases with complicated anatomies. For the description of turbulence caused by the diseased flow, there exist two types of parameters based on completely different concepts, namely: energy loss (EL) and turbulent kinetic energy (TKE). EL is the dissipated energy with blood viscosity and evaluates the cardiac workload related to the prognosis of heart failure. TKE describes the fluctuation in kinetic energy during turbulence, which describes the severity of the diseases that cause jet flow. These parameters are based on intuitive and clear physiological concepts, and are suitable for in vivo flow measurements using inner velocity profiles.

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Aortic Vorticity, Helicity, and Aortopathy in Adult Patients with Tetralogy of Fallot: Pilot Study Using Four-Dimensional Flow Magnetic Resonance Images

Cited by 8 publications

References 15 publications

Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot

Impaired ascending aortic elasticity in fetuses with tetralogy of Fallot

Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications

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