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Author Notes:

Ajit P. Yoganathan, PhD, The Wallace H. Coulter Distinguished Faculty Chair in Biomedical Engineering & Regent’s Professor, Associate Chair for Research, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 313 Ferst Dr, Atlanta, GA 30332 (ajit.yoganathan@bme.gatech.edu).

Authors have nothing to disclose with regard to commercial support.

Subjects:

Research Funding:

Supported by the National Heart, Lung, and Blood Institute (grant HL-67622); and an American Heart Association (AHA) Predoctoral Fellowship (grant 0715374B).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Respiratory System
  • Surgery
  • Cardiovascular System & Cardiology
  • TOTAL CAVOPULMONARY CONNECTION
  • COMPUTATIONAL FLUID-DYNAMICS
  • RECONSTRUCTION
  • INTERPOLATION
  • INTRAATRIAL

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

Tools:

Journal Title:

Journal of Thoracic and Cardiovascular Surgery

Volume:

Volume 143, Number 5

Publisher:

, Pages 1108-1116

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

Copyright © 2012 by The American Association for Thoracic Surgery.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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