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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: riesenkampff@dhzb.de
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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 

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