Three-dimensional and four-dimensional flow assessment in congenital heart disease

Abstract

Congenital heart disease (CHD) is the most common form of congenital defects, with an incidence of 8 per 1000 births. Due to major advances in diagnostics, perioperative care and surgical techniques, the survival rate of patients with CHD has improved dramatically. Conversely, although 70%–95% of infants with CHD survive into adulthood, the rate of long-term morbidity, which often requires (repeat) intervention, has increased. Recently, the role of altered haemodynamics in cardiac development and CHD has become a subject of interest. Patients with CHD often have abnormal blood flow patterns, either due to the primary cardiac defect or as a consequence of the surgical intervention(s). Research suggests that these abnormal blood flow patterns may contribute to diminished cardiac and vascular function. Serial assessment of haemodynamic parameters in patients with CHD may allow for improved understanding of the often complex haemodynamics in these patients and thereby potentially guide the timing and nature of interventions with the aim of preventing progression of cardiovascular deterioration. In this article we will discuss two novel non-invasive four-dimensional (4D) techniques to evaluate cardiovascular haemodynamics: 4D-flow cardiac magnetic resonance and computational fluid dynamics. This review focuses on the additional value of these two modalities in the evaluation of patients with CHD with abnormal flow patterns, who could benefit from advanced haemodynamic evaluation: patients with coarctation of the aorta, bicuspid aortic valve, tetralogy of Fallot and patients after Fontan palliation.

Pulmonary artery hemodynamic assessment of blood flow characteristics in repaired tetralogy of Fallot patients versus healthy child volunteers

“…In our study, there were correlations between peak systolic EL and RVEDV i /RVESVi in the RPA. These inefficiencies changed performance such as in the areas of pulmonary vascular reserve, ventricular remodeling, and decreased performance (31). Our study supports the possibility that hemodynamic changes are associated with ventricular deterioration and may be helpful in understanding how PA-RV interactions impact RV function.…”

Imaging of complications following Fontan circulation in children — diagnosis and surveillance

“…Functional flow data can be provided by 2-D phase-contrast sequences, while newer quantitative MR techniques like 4-D flow with computational fluid dynamics are under research and in clinical use in a few institutions and require specific software analysis tools (Fig. 8 ) [ 37 – 39 ]. MR strain analysis and feature tracking are, like echocardiography, newer techniques that are garnering more attention to how diastolic and systolic function perform in the single-ventricle circulation and also in pediatric patients [ 28 , 34 ].…”

Current and Future Aspects of Multimodal Imaging, Diagnostic, and Treatment Strategies in Bicuspid Aortic Valve and Associated Aortopathies

“…The different imaging modalities assess the anatomical progression of the bicuspid aortic valve and usually only record the anatomical alterations of the vessels and heart valves and not the rheological load on the aortic wall. Using the results from 2D phase contrast (PC) CMR studies, some research groups evaluated the hemodynamically forces on the aortic wall using 4D flow [10]. In contrast to 2D PC-CMR, the 3D PC-CMR with three-directional velocity encoding (4D flow) comprises information on the in vivo 3D blood flow dynamics with full volumetric data set of the thoracic aorta and time in the cardiac cycle.…”