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

Kartik S. Sundareswaran, Christopher M. Haggerty, Diane De Zélicourt, Lakshmi P. Dasi, Kerem Pekkan, David Frakes, Andrew J. Powell, Kirk R. Kanter, Mark A. Fogel, Ajit P. Yoganathan

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1108-1116
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number5
DOIs
StatePublished - May 2012

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Magnetic Resonance Imaging
Venae Cavae
Pulmonary Artery
Superior Vena Cava
Inferior Vena Cava
Hemodynamics
Pediatrics
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Visualization of flow structures in Fontan patients using 3-dimensional phase contrast magnetic resonance imaging. / Sundareswaran, Kartik S.; Haggerty, Christopher M.; De Zélicourt, Diane; Dasi, Lakshmi P.; Pekkan, Kerem; Frakes, David; Powell, Andrew J.; Kanter, Kirk R.; Fogel, Mark A.; Yoganathan, Ajit P.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 5, 05.2012, p. 1108-1116.

Research output: Contribution to journalArticle

Sundareswaran, KS, Haggerty, CM, De Zélicourt, D, Dasi, LP, Pekkan, K, Frakes, D, Powell, AJ, Kanter, KR, Fogel, MA & Yoganathan, AP 2012, 'Visualization of flow structures in Fontan patients using 3-dimensional phase contrast magnetic resonance imaging', Journal of Thoracic and Cardiovascular Surgery, vol. 143, no. 5, pp. 1108-1116. https://doi.org/10.1016/j.jtcvs.2011.09.067
Sundareswaran, Kartik S. ; Haggerty, Christopher M. ; De Zélicourt, Diane ; Dasi, Lakshmi P. ; Pekkan, Kerem ; Frakes, David ; Powell, Andrew J. ; Kanter, Kirk R. ; Fogel, Mark A. ; Yoganathan, Ajit P. / Visualization of flow structures in Fontan patients using 3-dimensional phase contrast magnetic resonance imaging. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 5. pp. 1108-1116.
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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.",
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AU - Dasi, Lakshmi P.

AU - Pekkan, Kerem

AU - Frakes, David

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