Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-24T13:51:26.684Z Has data issue: false hasContentIssue false
  • English
  • Français

Flow-sensitive four-dimensional velocity-encoded magnetic resonance imaging reveals abnormal blood flow patterns in the aorta and pulmonary trunk of patients with transposition

Published online by Cambridge University Press:  18 January 2013

Eugénie Riesenkampff ,
Sarah Nordmeyer ,
Nadya Al-Wakeel ,
Siegfried Kropf ,
Shelby Kutty ,
Felix Berger  and
Titus Kuehne
Eugénie Riesenkampff*
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Unit of Cardiovascular Imaging, Deutsches Herzzentrum Berlin, Berlin, Germany
Sarah Nordmeyer
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Unit of Cardiovascular Imaging, Deutsches Herzzentrum Berlin, Berlin, Germany
Nadya Al-Wakeel
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Unit of Cardiovascular Imaging, Deutsches Herzzentrum Berlin, Berlin, Germany
Siegfried Kropf
Affiliation:
Institute for Biometrics and Medical Informatics, University of Magdeburg, Magdeburg, Germany
Shelby Kutty
Affiliation:
Division of Pediatric Cardiology, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, Nebraska, United States of America
Felix Berger
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Unit of Cardiovascular Imaging, Deutsches Herzzentrum Berlin, Berlin, Germany
Titus Kuehne
Affiliation:
Department of Congenital Heart Disease and Paediatric Cardiology, Unit of Cardiovascular Imaging, Deutsches Herzzentrum Berlin, Berlin, Germany
*
Correspondence to: Dr med. E. Riesenkampff, Department of Congenital Heart Disease and Paediatric Cardiology, Unit of Cardiovascular Imaging, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 30 4593 2800; Fax: +49 30 45932900; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and objectives

Flow profiles are important determinants of fluid–vessel wall interactions. The aim of this study was to assess blood flow profiles in the aorta and pulmonary trunk in patients with transposition and different ventriculoarterial connection, and hence different mechanics of the coherent pump.

Methods

In all, 29 patients with operated transposition – concordant atrioventricular and discordant ventriculoarterial connection, and no other cardiac malformation – and eight healthy volunteers were assessed with cardiac magnetic resonance imaging: n = 17 patients after atrial redirection, with a morphologic right ventricle acting as systemic pump and a morphologic left ventricle connected to the pulmonary trunk, and n = 12 patients after the arterial switch procedure, with physiologic ventriculoarterial connections. Flow-sensitive four-dimensional velocity-encoded magnetic resonance imaging was used to analyse systolic flow patterns in the aorta and pulmonary trunk, relating to helical flow and vortex formation.

Results

In the aorta, overall helicity was present in healthy volunteers, but it was absent in all patients independent on the operation technique. Partial helices were observed in the ascending aorta of 58% of patients after arterial switch. In the pulmonary trunk, mostly parallel flow was seen in healthy volunteers and in patients after arterial switch, whereas vortex formation was present in 88% of patients after atrial redirection.

Conclusion

Blood flow patterns differ substantially between the groups. In addition to varying mechanics of the coherent pumping ventricles, the absent overall helicity in all patients might be explained by the missing looping of the aorta in transposition.

Keywords

Transpositionflow-sensitive four-dimensional velocity-encoded cine magnetic resonance imagingblood flow visualisation
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 47 - 53
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Warnes, CA. Transposition of the great arteries. Circulation 2006; 114: 2699–2709.Google Scholar
2. Jatene, AD, Fontes, VF, Paulista, PP, et al. Successful anatomic correction of transposition of the great vessels: a preliminary report. Arq Bras Cardiol 1975; 28: 461–464.Google ScholarPubMed
3. Jatene, AD, Fontes, VF, Paulista, PP, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg 1976; 72: 364–370.Google Scholar
4. Markl, M, Kilner, PJ, Ebbers, T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2011; 13: 7.Google Scholar
5. Nordmeyer, S, Berger, F, Kuehne, T, Riesenkampff, E. Flow-sensitive four-dimensional magnetic resonance imaging facilitates and improves the accurate diagnosis of partial anomalous pulmonary venous drainage. Cardiol Young 2011; 21: 528–535.Google Scholar
6. Nordmeyer, S, Riesenkampff, E, Crelier, G, et al. Flow-sensitive four-dimensional cine magnetic resonance imaging for offline blood flow quantification in multiple vessels: a validation study. J Magn Reson Imaging 2010; 32: 677–683.Google Scholar
7. Valverde, I, Nordmeyer, S, Uribe, S, et al. Systemic-to-pulmonary collateral flow in patients with palliated univentricular heart physiology: measurement using cardiovascular magnetic resonance 4D velocity acquisition. J Cardiovasc Magn Reson 2012; 14: 25.Google Scholar
8. Reiter, G, Reiter, U, Kovacs, G, et al. Magnetic resonance-derived 3-dimensional blood flow patterns in the main pulmonary artery as a marker of pulmonary hypertension and a measure of elevated mean pulmonary arterial pressure. Circ Cardiovasc Imaging 2008; 1: 23–30.Google Scholar
9. Frydrychowicz, A, Markl, M, Hirtler, D, et al. Aortic hemodynamics in patients with and without repair of aortic coarctation: in vivo analysis by 4D flow-sensitive magnetic resonance imaging. Invest Radiol 2011; 46: 317–325.Google Scholar
10. Chiu, JJ, Chien, S. Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev 2011; 91: 327–387.Google Scholar
11. Geiger, J, Markl, M, Jung, B, et al. 4D-MR flow analysis in patients after repair for tetralogy of Fallot. Eur Radiol 2011; 21: 1651–1657.Google Scholar
12. Markl, M, Geiger, J, Kilner, PJ, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of cardiovascular flow paths in volunteers and patients with Fontan circulation. Eur J Cardiothorac Surg 2011; 39: 206–212.CrossRefGoogle ScholarPubMed
13. Beerbaum, P, Barth, P, Kropf, S, et al. Cardiac function by MRI in congenital heart disease: impact of consensus training on interinstitutional variance. J Magn Reson Imaging 2009; 30: 956–966.Google Scholar
14. Riesenkampff, EM, Schmitt, B, Schnackenburg, B, et al. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging. Pediatr Cardiol 2009; 30: 458–464.Google Scholar
15. Kutty, S, Kuehne, T, Gribben, P, et al. Ascending aortic and main pulmonary artery areas derived from cardiovascular magnetic resonance as reference values for normal subjects and repaired tetralogy of Fallot. Circ Cardiovasc Imaging 2012; 5: 644–651.CrossRefGoogle ScholarPubMed
16. Massin, MM, Nitsch, GB, Dabritz, S, Seghaye, MC, Messmer, BJ, von Bernuth, G. Growth of pulmonary artery after arterial switch operation for simple transposition of the great arteries. Eur J Pediatr 1998; 157: 95–100.Google Scholar
17. Grotenhuis, HB, Ottenkamp, J, Fontein, D, et al. Aortic elasticity and left ventricular function after arterial switch operation: MR imaging – initial experience. Radiology 2008; 249: 801–809.Google Scholar
18. Grothoff, M, Fleischer, A, Abdul-Khaliq, H, et al. The systemic right ventricle in congenitally corrected transposition of the great arteries is different from the right ventricle in dextro-transposition after atrial switch: a cardiac magnetic resonance study. Cardiol Young 2012; 14: 1–9.Google Scholar
19. Pettersen, E, Helle-Valle, T, Edvardsen, T, et al. Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 2007; 49: 2450–2456.Google Scholar
20. Wilson, NJ, Clarkson, PM, Barratt-Boyes, BG, et al. Long-term outcome after the mustard repair for simple transposition of the great arteries: 28-year follow-up. J Am Coll Cardiol 1998; 32: 758–765.Google Scholar
21. Yehya, A, Lyle, T, Pernetz, MA, McConnell, ME, Kogon, B, Book, WM. Pulmonary arterial hypertension in patients with prior atrial switch procedure for d-transposition of great arteries (dTGA). Int J Cardiol 2010; 143: 271–275.Google Scholar
22. Marino, B, Corno, AF. Spiral pattern: universe, normal heart, and complex congenital defects. J Thorac Cardiovasc Surg 2003; 126: 1225–1226.Google Scholar
23. Kilner, PJ, Yang, GZ, Mohiaddin, RH, Firmin, DN, Longmore, DB. Helical and retrograde secondary flow patterns in the aortic arch studied by three-directional magnetic resonance velocity mapping. Circulation 1993; 88: 2235–2247.Google Scholar
24. Chiu, IS, Huang, SC, Chen, YS, et al. Restoring the spiral flow of nature in transposed great arteries. Eur J Cardiothorac Surg 2010; 37: 1239–1245.Google Scholar
25. Li, H, Leow, WK, Chiu, IS. Modeling torsion of blood vessels in surgical simulation and planning. Stud Health Technol Inform 2009; 142: 153–158.Google ScholarPubMed
26. Ding, Z, Fan, Y, Deng, X, Zhan, F, Kang, H. Effect of swirling flow on the uptakes of native and oxidized LDLs in a straight segment of the rabbit thoracic aorta. Exp Biol Med (Maywood) 2010; 235: 506–513.Google Scholar
27. Frydrychowicz, A, Berger, A, Munoz Del Rio, A, et al. Interdependencies of aortic arch secondary flow patterns, geometry, and age analysed by 4-dimensional phase contrast magnetic resonance imaging at 3 Tesla. Eur Radiol 2012; 22: 1122–1130.Google Scholar
28. Agnoletti, G, Ou, P, Celermajer, DS, et al. Acute angulation of the aortic arch predisposes a patient to ascending aortic dilatation and aortic regurgitation late after the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2008; 135: 568–572.Google Scholar
29. Rudolph, AM. Aortopulmonary transposition in the fetus: speculation on pathophysiology and therapy. Pediatr Res 2007; 61: 375–380.CrossRefGoogle ScholarPubMed
30. Mersich, B, Studinger, P, Lenard, Z, Kadar, K, Kollai, M. Transposition of great arteries is associated with increased carotid artery stiffness. Hypertension 2006; 47: 1197–1202.Google Scholar
31. Carlsson, M, Ugander, M, Heiberg, E, Arheden, H. The quantitative relationship between longitudinal and radial function in left, right, and total heart pumping in humans. Am J Physiol Heart Circ Physiol 2007; 293: 636–644.Google Scholar