Counter-clockwise vortical blood flow in the main pulmonary artery in a patient with patent ductus arteriosus with pulmonary arterial hypertension: a cardiac magnetic resonance imaging case report

Abstract

BackgroundIn patients with pulmonary hypertension (PH), duration of vortical blood flow along the main pulmonary artery enables estimation of the mean pulmonary arterial pressure (mPAP) non-invasively. It remains to date not known, if this method is applicable in patients with pulmonary arterial hypertension (PAH) and abnormal aortic-to-pulmonary shunting.Case presentationThe present case analyzes the effect of a patent ductus arteriosus (PDA) on pulmonary artery flow patterns in PAH (mPAP from right heart catheterization, 75 mmHg). PH-associated vortical blood flow, which is typically observed rotating in a clockwise direction when viewed in right ventricular outflow tract orientation, was found nested in PDA left-to-right shunting. Even though rotating counter-clockwise, duration of vortical flow translated into correct non-invasive mPAP estimate.ConclusionsThis case indicates that PH-associated vortex rotation is not restricted to clockwise direction, and that vortex-based estimation of elevated mPAP might also be feasible in patients with PAH and PDA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-016-0150-z) contains supplementary material, which is available to authorized users.

Diagnosis of Pulmonary Hypertension with Cardiac MRI: Derivation and Validation of Regression Models

“…This is likely to be a composite of slow flow and vortical or turbulent flow within the pulmonary artery. The increasing use of four-dimensional phase-contrast flow imaging will likely allow this metric within the model to be improved upon (22–24). The parameters of black blood imaging that are susceptible to flow artifacts (section thickness, inversion time, echo time, echo train length, and cardiac triggering point) were kept the same between patients and could be easily adopted for standardized use in different centers.…”

4D-flow MRI assessment of blood flow before and after endovascular intervention in a patient with pulmonary hypertension due to isolated pulmonary artery involvement in large vessel vasculitis

“…We encountered a patient with PH due to isolated pulmonary artery involvement in large-vessel vasculitis, and evaluated the perioperative hemodynamic changes using 4D-flow MRI. Such perioperative assessments have been reported in cardiovascular and cerebrovascular diseases, and have demonstrated the importance of hemodynamic changes in surgical planning or therapeutic effects [1], [2], [3], [4], [5], [6], [7], [8], [9]. In patients with PH, Reiter et al demonstrated a relationship between mean PAP and vortical blood flow in the main pulmonary artery [1].…”

“…However, it cannot simultaneously depict blood flow in all pulmonary arteries due to its limited acoustic window. Three-dimensional phase-contrast magnetic resonance imaging (4D-flow MRI) is a less-invasive imaging procedure developed for the quantitative evaluation of blood flow through the heart and large vessels during cardiac cycles [1], [2], [3], [4], [5], [6]. We investigated perioperative hemodynamic changes in a patient with PH using 4D-flow MRI.…”

Quantitative evaluation of pulmonary hypertension using 4D flow MRI: A retrospective study

“…Recently, 3-dimensional (3D) phase-contrast magnetic resonance imaging (MRI) (4D flow MRI) has been developed as a minimally invasive method to quantitatively evaluate blood flow through the heart and large vessels during cardiac cycles [ [10] , [11] , [12] , [13] , [14] ]. Furthermore, the characteristic blood flow in PH can be visualized using 4D flow MRI [ 15 , 16 ]. Therefore, this technique may be a useful noninvasive, nonionizing method to diagnose and monitor PH patients.…”