Helical flow pattern in the right pulmonary artery after Fontan palliation

Houtzager, Julia; Westenberg, Jos J.M.; Koning, Patrick J.H. de; Hazekamp, Mark G.; Roest, Arno A.W.

doi:10.1093/ehjci/jeu096

Cited by 4 publications

(5 citation statements)

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“…As expected, this results in altered pulmonary and caval blood flow patterns [38]. As these patients require lifelong follow-up, accurate visualization and quantification of flow patterns is crucial.…”

Section: Applicationsmentioning

confidence: 85%

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Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Kamphuis

Westenberg

Palen

et al. 2016

Int J Cardiovasc Imaging

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Knowledge of normal and abnormal flow patterns in the human cardiovascular system increases our understanding of normal physiology and may help unravel the complex pathophysiological mechanisms leading to cardiovascular disease. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has emerged as a suitable technique that enables visualization of in vivo blood flow patterns and quantification of parameters that could potentially be of prognostic value in the disease process. In this review, current image processing tools that are used for comprehensive visualization and quantification of blood flow and energy distribution in the heart and great vessels will be discussed. Also, imaging biomarkers extracted from 4D flow CMR will be reviewed that have been shown to distinguish between normal and abnormal flow patterns. Furthermore, current applications of 4D flow CMR in the heart and great vessels will be discussed, showing its potential as an additional diagnostic modality which could aid in disease management and timing of surgical intervention.

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Section: Applicationsmentioning

confidence: 85%

“…Pathlines are then calculated by integration over time: backward tracing over the diastole and forward tracing over systole. Pathlines are also frequently used to evaluate complex flow patterns, such as helical flow patterns in the aorta and pulmonary artery [34, 38]. …”

Section: Visualization and Quantificationmentioning

confidence: 99%

Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Kamphuis

Westenberg

Palen

et al. 2016

Int J Cardiovasc Imaging

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“…Previous studies using CFD, in vitro models or 4D flow MRI have shown the presence of adverse secondary flow patterns, including helical, swirling flow patterns at the IVC-to-conduit junction ( 55 ) and in the PAs ( 56 , 57 ) or caval flow collision leading to chaotic flow disturbances at the central Fontan confluence ( 58 , 59 ). The appearance of adverse, energy-consuming flow patterns increase blood flow resistance that may lead to an increased risk of complications ( 14 ).…”

Section: Effect Of Respiration On Clinically Used Flow Parametersmentioning

confidence: 99%

The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection

Woude

Rijnberg

Hazekamp

et al. 2021

Front. Cardiovasc. Med.

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Congenital heart disease is the most common birth defect and functionally univentricular heart defects represent the most severe end of this spectrum. The Fontan circulation provides an unique solution for single ventricle patients, by connecting both caval veins directly to the pulmonary arteries. As a result, the pulmonary circulation in Fontan palliated patients is characterized by a passive, low-energy circulation that depends on increased systemic venous pressure to drive blood toward the lungs. The absence of a subpulmonary ventricle led to the widely believed concept that respiration, by sucking blood to the pulmonary circulation during inspiration, is of great importance as a driving force for antegrade blood flow in Fontan patients. However, recent studies show that respiration influences pulsatility, but has a limited effect on net forward flow in the Fontan circulation. Importantly, since MRI examination is recommended every 2 years in Fontan patients, clinicians should be aware that most conventional MRI flow sequences do not capture the pulsatility of the blood flow as a result of the respiration. In this review, the unique flow dynamics influenced by the cardiac and respiratory cycle at multiple locations within the Fontan circulation is discussed. The impact of (not) incorporating respiration in different MRI flow sequences on the interpretation of clinical flow parameters will be covered. Finally, the influence of incorporating respiration in advanced computational fluid dynamic modeling will be outlined.

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“…Four-dimensional flow MRI has revealed abnormal flow patterns within the TCPC, including helical and vortical flow in the PAs and Fontan confluence, 7 , 9 , 10 at the junction between the inferior vena cava (IVC) and extracardiac conduit 6 or in an attached, blind-ending pulmonary trunk. 8 However, how these flow patterns relate to quantitative energetics within these segments with altered flow is not known.…”

Section: Discussionmentioning

confidence: 99%

Segmental assessment of blood flow efficiency in the total cavopulmonary connection using four-dimensional flow magnetic resonance imaging: vortical flow is associated with increased viscous energy loss rate

Rijnberg

Juffermans

Hazekamp

et al. 2021

European Heart Journal Open

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Objectives To study flow-related energetics in multiple anatomical segments of the total cavopulmonary connection (TCPC) in Fontan patients from 4D flow MRI, and to study the relationship between adverse flow patterns and segment-specific energetics. Methods Twenty-six extracardiac Fontan patients underwent 4D flow MRI of the TCPC. A segmentation of the TCPC was automatically divided into 5 anatomical segments (conduit, superior vena cava, right/left pulmonary artery (PA) and the Fontan confluence). The presence of vortical flow in the PAs or Fontan confluence was qualitatively scored. Kinetic energy, viscous energy loss and vorticity were calculated from the 4D flow MRI velocity field and normalized for segment length and/or inflow. Energetics were compared between segments and the relationship between vortical flow and segment cross-sectional area (CSA) with segment-specific energetics was determined. Results Vortical flow in the LPA (n = 6) and Fontan confluence (n = 12) were associated with significantly higher vorticity (p = 0.001 and p = 0.015, respectively) and viscous energy loss rate (p = 0.046 and p = 0.04, respectively) compared to patients without vortical flow. The LPA and conduit segments showed the highest kinetic energy and viscous energy loss rate, while most favorable energetics were observed in the superior vena cava. Conduit CSA inversely correlated with kinetic energy (r= -0.614, p = 0.019) and viscous energy loss rate (r= -0.652, p = 0.011). Conclusions Vortical flow in the Fontan confluence and LPA associated with significantly increased viscous energy loss rate. 4D flow MRI derived energetics may be used as a screening tool for direct, MRI-based assessment of flow efficiency in the TCPC.

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Helical flow pattern in the right pulmonary artery after Fontan palliation

Cited by 4 publications

References 0 publications

Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance

The Influence of Respiration on Blood Flow in the Fontan Circulation: Insights for Imaging-Based Clinical Evaluation of the Total Cavopulmonary Connection

Segmental assessment of blood flow efficiency in the total cavopulmonary connection using four-dimensional flow magnetic resonance imaging: vortical flow is associated with increased viscous energy loss rate

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