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      Evaluation of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI

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          Abstract

          Background

          Asymmetrical caval to pulmonary blood flow is suspected to cause complications in patients with Fontan circulation. The aim of this study was to test the feasibility of 4-D flow MRI for characterizing the relationship between 3-D blood flow distribution and vascular geometry.

          Objective

          We hypothesized that both flow distribution and geometry can be calculated with low interobserver variability and will detect a direct relationship between flow distribution and Fontan geometry.

          Materials and methods

          Four-dimensional flow MRI was acquired in 10 Fontan patients (age: 16±4 years [mean ± standard deviation; range 9–21 years]). The Fontan connection was isolated by 3-D segmentation to evaluate flow distribution from the inferior vena cava (IVC) and superior vena cava (SVC) to the left and right pulmonary arteries (LPA, RPA) and to characterize geometry (cross-sectional area, caval offset, vessel angle).

          Results

          Flow distribution results indicated SVC flow tended toward the RPA while IVC flow was more evenly distributed (SVC to RPA: 78%±28 [9–100], IVC to LPA: 54%±28 [4–98]). There was a significant relationship between pulmonary artery cross-sectional area and flow distribution (IVC to RPA: R 2=0.50, P=0.02; SVC to LPA: R 2=0.81, P=0.0004). Good agreement was found between observers and for flow distribution when compared to net flow values.

          Conclusion

          Four-dimensional (4-D) flow MRI was able to detect relationships between flow distribution and vessel geometry. Future studies are warranted to investigate the potential of patient specific hemodynamic analysis to improve diagnostic capability.

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          Author and article information

          Journal
          0365332
          6399
          Pediatr Radiol
          Pediatr Radiol
          Pediatric radiology
          0301-0449
          1432-1998
          22 July 2016
          27 June 2016
          October 2016
          01 October 2017
          : 46
          : 11
          : 1507-1519
          Affiliations
          [1 ]Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., Suite 1600, Chicago, IL 60611, USA
          [2 ]Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA
          [3 ]Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
          [4 ]Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
          [5 ]Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
          [6 ]Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
          Author notes
          Article
          PMC5039076 PMC5039076 5039076 nihpa800184
          10.1007/s00247-016-3654-3
          5039076
          27350377
          2854ec7c-0725-4ece-bdee-89ccdd59fcd1
          History
          Categories
          Article

          Cardiovascular magnetic resonance,Children,Congenital heart disease,Fontan,Four-dimensional flow magnetic resonance imaging,Heart

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