Visualization of flow structures in Fontan patients using 3-dimensional phase contrast magnetic resonance imaging

• Type of Material: Article
• Authors: Kartik S. Sundareswaran, Georgia Institute of Technology; Christopher M. Haggerty, Georgia Institute of Technology; Diane de Zelicourt, Georgia Institute of Technology; Lakshmi P. Dasi, Colorado State University; Kerem Pekkan, Carnegie Mellon University; David H. Frakes, Arizona State University; Andrew J. Powell, Children’s Hospital Boston; Kirk R Kanter, Emory University; Mark A. Fogel, Children's Hospital of Philadelphia; Ajit Yoganathan, Emory University
• Language: English
• Date: 2012-05-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2012 by The American Association for Thoracic Surgery.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jtcvs.2011.09.067
• Title of Journal or Parent Work: Journal of Thoracic and Cardiovascular Surgery
• ISSN: 0022-5223
• Volume: 143
• Issue: 5
• Start Page: 1108
• End Page: 1116
• Grant/Funding Information: Supported by the National Heart, Lung, and Blood Institute (grant HL-67622); and an American Heart Association (AHA) Predoctoral Fellowship (grant 0715374B).
• Keywords: COMPUTATIONAL FLUID-DYNAMICS; Life Sciences & Biomedicine; Respiratory System; INTERPOLATION; Science & Technology; Surgery; Cardiovascular System & Cardiology; RECONSTRUCTION; INTRAATRIAL; TOTAL CAVOPULMONARY CONNECTION; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

Objective: Our objective was to analyze 3-dimensional (3D) blood flow patterns within the total cavopulmonary connection (TCPC) using in vivo phase contrast magnetic resonance imaging (PC MRI). Methods: Sixteen single-ventricle patients were prospectively recruited at 2 leading pediatric institutions for PC MRI evaluation of their Fontan pathway. Patients were divided into 2 groups. Group 1 comprised 8 patients with an extracardiac (EC) TCPC, and group 2 comprised 8 patients with a lateral tunnel (LT) TCPC. A coronal stack of 5 to 10 contiguous PC MRI slices with 3D velocity encoding (5-9 ms resolution) was acquired and a volumetric flow field was reconstructed. Results: Analysis revealed large vortices in LT TCPCs and helical flow structures in EC TCPCs. On average, there was no difference between LT and EC TCPCs in the proportion of inferior vena cava flow going to the left pulmonary artery (43% ± 7% vs 46% ± 5%; P = .34). However, for EC TCPCs, the presence of a caval offset was a primary determinant of inferior vena caval flow distribution to the pulmonary arteries with a significant bias to the offset side. Conclusions: 3D flow structures within LT and EC TCPCs were reconstructed and analyzed for the first time using PC MRI. TCPC flow patterns were shown to be different, not only on the basis of LT or EC considerations, but with significant influence from the superior vena cava connection as well. This work adds to the ongoing body of research demonstrating the impact of TCPC geometry on the overall hemodynamic profile.