Characterization and improved quantification of left ventricular inflow using streamline visualization with 4DFlow MRI in healthy controls and patients after atrioventricular septal defect correction

Abstract

Streamline visualization of 4DFlow MRI data revealed dynamic trans-LAVV inflow and more lateral flow after AVSD correction. Streamline visualization improved trans-LAVV flow quantification as the positioning and angulation of the measurement plane was optimized, allowing an accurate assessment of left ventricular inflow.

Disturbed Intracardiac Flow Organization After Atrioventricular Septal Defect Correction as Assessed With 4D Flow Magnetic Resonance Imaging and Quantitative Particle Tracing

“…23 The high percentage of particles in inferior, inferolateral, and anterolateral segments is in line with visually described flow patterns in the LV as reported by Eriksson et al 9 Corrected AVSD Patients Patients with corrected AVSD had a reduced percentage of direct flow but increased delayed ejection flow, resulting in a similar stroke volume as in healthy controls, as was also observed in patients with dilated cardiomyopathy. 11 The increased portion of (mainly retained) inflow particles flowing through the mid anterolateral and inferolateral segments is in line with our previous report using 2D streamline visualization, describing more lateral inflow in corrected AVSD patients, 4 and can be explained by the restricted opening of the valve because of cleft closure. In addition, the offset between the interatrial and interventricular septum in AVSD hearts may influence inflow direction.…”

“…1,2,19 Using 2D streamline visualization, a previous cardiac magnetic resonance study showed a more lateral inflow direction in corrected AVSD patients. 4 On the basis of these observations, we aimed to study the effect of this altered inflow after AVSD correction on intracardiac flow organization. Particle tracing allows visualization of the pathlines of blood flow over time.…”

“…Trans-LAVV flow analysis was performed using through-plane velocity mapping with the use of retrospective valve tracking as described previously. 4 Peak velocity during E-peak filling and A-peak filling was determined from the trans-LAVV velocity-time curves. A cine multi-2D short-axis image set was acquired using steady-state free-precession sequence with TE/TR of 1.5/3.0, 350-mm field of view, 45°flip angle, and acquisition resolution of 1.0 Â 1.0 Â 8.0 mm 3 , which was used to obtain the LV volume after segmentation of the LV contours.…”

“…The normal pathway of blood flowing through the LV, from inflow through the mitral valve toward ejection into the aorta, optimizes the efficiency of cardiac pumping. 3 Magnetic resonance imaging (MRI)-based streamline evaluation in corrected AVSD patients revealed a more lateral inflow direction, 4 which may disturb the most efficient intraventricular blood flow organization 5 and may also affect cardiac pumping efficiency and eventually lead to ventricular remodeling. 6,7 An evaluation of the organization of intracardiac blood flow is possible with particle tracing 8 from 4-dimensional (3 spatial directions and time) velocity-encoded MRI (4d flow MRI).…”

Hierarchical Shape Distributions for Automatic Identification of 3D Diastolic Vortex Rings from 4D Flow MRI

“…Finally, simultaneous identification of isovalue and vortex ring is achieved using hierarchical clustering that allows for an iterative search for the best D2 shape distribution match with the reference signature. To evaluate the objectivity and generalizability of the proposed method in a clinical setup, the defined vortex ring was quantified using the method introduced in [3] in a dataset of 24 healthy controls as well as in a challenging dataset of 23 congenital heart disease patients who were previously reported to have abnormal diastolic inflow [12].…”