Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T22:19:49.512Z Has data issue: false hasContentIssue false
  • English
  • Français

Utility of 4D Flow mapping in Eisenmenger syndrome with pulmonary atresia

Published online by Cambridge University Press:  02 February 2017

Soha Romeih ,
Heba Aguib  and
Magdi Yacoub
Soha Romeih
Affiliation:
Paediatric Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt Radiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
Heba Aguib
Affiliation:
Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
Magdi Yacoub*
Affiliation:
Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt Harefield Heart Science Centre, National Heart and Lung Institute, Imperial College London, London, UK
*
Correspondence to: M. Yacoub, Aswan Heart Centre-Magdi Yacoub Foundation, Kasr ElHagger Street, Aswan 81513, Egypt. Tel: +2(079)2312947; Fax: +2(097)2312847; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Management of patients with Eisenmenger syndrome with pulmonary atresia is challenging because of the complexity of the structure–function relationship of the components of the syndrome. Multi-modality imaging including cardiac magnetic resonance (CMR) 4D Flow offers unprecedented opportunities to unravel, at least in part, some of these components, and thus help in the management of these patients. In this study, we describe the use of these integrated methods with particular reference to CMR 4D Flow in a patient with Eisenmenger syndrome and pulmonary atresia and outline both the utility and the limitations. A comprehensive cardiac magnetic resonance (CMR) 4D Flow analysis was performed preoperatively and postoperatively, during peak systole, late systole, early diastole, and late diastole. The focus of the present study was to investigate the pattern of flow and dynamic changes at different levels of the aorta, as well as in the duct and the pulmonary arteries. Preoperatively, a right-handed helix and a vortex were observed in the dilated ascending aorta, and the duct flow was mainly dependent on reverse, upstream flow from the descending aorta, distal to the duct, during diastole, denoting low pulmonary vascular capacitance. Following repair, the flow in the ascending aorta and the descending aorta changed markedly. These changes included both timing and intensity of the right-handed helix, as well as the vortex in the ascending aorta. The significance of the observed changes in flow pattern and their influence on wall structure and function are discussed. Our study demonstrates the extremely powerful potential of CMR 4D Flow in the management of complex congenital anomalies.

Keywords

Eisenmenger syndromepulmonary atresiaCMR 4D Flowflow patterndecision making
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Special Issue 8: HeartWeek 2016 , December 2016 , pp. 1581 - 1589
Copyright
© Cambridge University Press 2017 

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.)

Footnotes

*

Equally contributed in the manuscript.

References

1. D’Alto, M, Merola, A, Dimopoulos, K. Pulmonary hypertension related to congenital heart disease: a comprehensive review. Global Cardiol Sci Pract 2015; 42: 1–17.Google Scholar
2. Reiter-Urgkbkksrm, G, Olschewski, H, Rienmueller, R. 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.CrossRefGoogle Scholar
3. Dyverfeldt, P, Bissell, M, Barker, AJ, et al. 4D flow cardiovascular magnetic resonance consensus statement. J Cardiovasc Magn Reson 2015; 17: 72.CrossRefGoogle ScholarPubMed
4. Kheradvar, A, Pedrizzetti, G. Vortex dynamics. Vortex Formation in the Cardiovascular System. Springer-Verlag, London, 2012: 17–45.Google Scholar
5. Kitabatake, A, Inoue, M, Asao, M, et al. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 1983; 68: 302–309.CrossRefGoogle ScholarPubMed
6. Davies, JE, Parker, KH, Francis, DP, et al. What is the role of the aorta in directing coronary blood flow? Heart 2008; 94: 1545–1547.CrossRefGoogle ScholarPubMed
7. Broyd, CJ, Davies, JE, Escaned, JE, et al. Wave intensity analysis and its application to the coronary circulation. Global Cardiol Sci Pract 2015; (5): 64.Google Scholar
8. Schultz, MG, Hughes, AD, Davies, JE, et al. Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation. Am J Physiol Heart Circ Physiol 2015; 309: H1225–H1233.CrossRefGoogle ScholarPubMed
9. Torii, R, Parker, KH, Yacoub, MH. Importance of stress mapping of aortic wall in aortic valve disease. J Am Coll Cardiol 2016; 67: 1755–1756.Google Scholar

Romeih supplementary material

Video 1

Download Romeih supplementary material(Video)
Video 2.2 MB

Romeih supplementary material

Video 2

Download Romeih supplementary material(Video)
Video 1.1 MB