TY - JOUR
T1 - Time-resolved three-dimensional magnetic resonance velocity mapping of cardiovascular flow paths in volunteers and patients with Fontan circulation
AU - Markl, Michael
AU - Geiger, Julia
AU - Kilner, Philip J.
AU - Föll, Daniela
AU - Stiller, Brigitte
AU - Beyersdorf, Friedhelm
AU - Arnold, Raoul
AU - Frydrychowicz, Alex
N1 - Funding Information:
§ Funding sources: Philip J. Kilner is supported by the British Heart Foundation. Michael Markl receives funding by the Bundesministerium für Bildung und Forschung (BMBF), Grant # 01EV0706. * Corresponding author. Tel.: +49 761 270 3832; fax: +49 761 270 3831. E-mail address: [email protected] (M. Markl).
PY - 2011/2
Y1 - 2011/2
N2 - Objective: To apply flow-sensitive magnetic resonance imaging for the evaluation of whole-heart flow characteristics in healthy volunteers and patients with Fontan circulation. Methods: Time-resolved three-dimensional magnetic resonance velocity mapping (spatial resolution=2.5×2.8×2.8mm3, temporal resolution=38.4ms) was acquired in normal controls and in four Fontan patients with extracardiac total cavopulmonary connection. Data analysis included flow connectivity mapping and flow quantification of arterial and venous blood flow. Haemodynamics in four patients with Fontan circulation were individually evaluated in the aorta, caval veins and left and right pulmonary arteries. Results: In four controls, nine distinct flow features were consistently identified with good feature clarity (median=2 in 80.6% of readings) and image quality (median=2 in 75.0% of readings). In patients, a marked variability of flow from the caval veins towards the left and right pulmonary arteries (flow ratio=1.7±0.6, range 1.2-2.6 vs 1.1±0.1 in controls) was found. Increased offset of the caval venous connection resulted in enhanced pulmonary flow asymmetry. Compared with controls, reduced pulsatility in pulmonary arteries (1.4±0.6 vs 4.1±0.6 in controls) and caval veins (1.2±0.4 vs 2.8±1.1 in controls) were observed. Peak flow was reduced in both superior (22±14mls-1 vs 76±7mls-1 in controls) and inferior vena cava (61±28mls-1 vs 187±42mls-1 in controls). Conclusions: This feasibility study demonstrated the potential of whole-heart three-dimensional magnetic resonance velocity mapping to reveal overt haemodynamic differences in surgically palliated congenital heart with similar extracardiac cavopulmonary connection geometry. Future studies are warranted to evaluate its diagnostic impact for improved evaluation of the pre- and postoperative status in the individual patient.
AB - Objective: To apply flow-sensitive magnetic resonance imaging for the evaluation of whole-heart flow characteristics in healthy volunteers and patients with Fontan circulation. Methods: Time-resolved three-dimensional magnetic resonance velocity mapping (spatial resolution=2.5×2.8×2.8mm3, temporal resolution=38.4ms) was acquired in normal controls and in four Fontan patients with extracardiac total cavopulmonary connection. Data analysis included flow connectivity mapping and flow quantification of arterial and venous blood flow. Haemodynamics in four patients with Fontan circulation were individually evaluated in the aorta, caval veins and left and right pulmonary arteries. Results: In four controls, nine distinct flow features were consistently identified with good feature clarity (median=2 in 80.6% of readings) and image quality (median=2 in 75.0% of readings). In patients, a marked variability of flow from the caval veins towards the left and right pulmonary arteries (flow ratio=1.7±0.6, range 1.2-2.6 vs 1.1±0.1 in controls) was found. Increased offset of the caval venous connection resulted in enhanced pulmonary flow asymmetry. Compared with controls, reduced pulsatility in pulmonary arteries (1.4±0.6 vs 4.1±0.6 in controls) and caval veins (1.2±0.4 vs 2.8±1.1 in controls) were observed. Peak flow was reduced in both superior (22±14mls-1 vs 76±7mls-1 in controls) and inferior vena cava (61±28mls-1 vs 187±42mls-1 in controls). Conclusions: This feasibility study demonstrated the potential of whole-heart three-dimensional magnetic resonance velocity mapping to reveal overt haemodynamic differences in surgically palliated congenital heart with similar extracardiac cavopulmonary connection geometry. Future studies are warranted to evaluate its diagnostic impact for improved evaluation of the pre- and postoperative status in the individual patient.
KW - Blood flow
KW - Congenital heart disease
KW - Extracardiac TCPC
KW - Fontan procedure
KW - MRI
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U2 - 10.1016/j.ejcts.2010.05.026
DO - 10.1016/j.ejcts.2010.05.026
M3 - Article
C2 - 20598560
AN - SCOPUS:78751580683
SN - 1010-7940
VL - 39
SP - 206
EP - 212
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 2
ER -