4D-Flow MRI Characterization of Pulmonary Flow in Repaired Tetralogy of Fallot

Patients with Tetralogy of Fallot (TOF) have multiple surgical sequelae altering the pulmonary flow hemodynamics. Repaired TOF (rTOF) adults frequently develop pulmonary regurgitation impacting the blood flow pressure, right ventricle load, and pulmonary hemodynamics. We aimed to evaluate the pulmonary flow hemodynamics using 4D-flow magnetic resonance imaging (MRI) for characterizing altered blood flow, viscous energy loss (EL), wall shear stress (WSS), pressure drop (PD), and ventricular flow analysis (VFA) in rTOF patients. We hypothesized that 4D-flow based parameters can identify pulmonary blood flow alterations. A total of 17 rTOF patients (age: 29 ± 10 years, 35% women) and 20 controls (age: 36 ± 12 years, 25% women) were scanned using a dedicated cardiac MRI protocol. Peak velocity and regurgitant fraction were significantly higher for rTOF patients (p < 0.001). WSS was consistently elevated along the PA in the rTOF (p ≤ 0.05). The rTOF average circumferential WSS was higher than axial WSS at the main pulmonary artery (p ≤ 0.001). PD and EL were consistently higher in the rTOF as compared with controls (p < 0.05). For VFA, delayed ejection increased and retained inflow decreased in rTOF patients (p < 0.001). To conclude, this study demonstrated that 4D-flow MRI pulmonary flow in the rTOF can exhibit altered peak velocity, valvular regurgitation, WSS, EL, PD, and VFA.

[1]  James A. White,et al.  Whole-Heart Assessment of Turbulent Kinetic Energy in the Repaired Tetralogy of Fallot , 2022, Applied Sciences.

[2]  M. Voskuil,et al.  Four-dimensional flow CMR in tetralogy of fallot: current perspectives. , 2022, The British journal of radiology.

[3]  L. Zhong,et al.  Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study , 2022, Journal of Cardiovascular Magnetic Resonance.

[4]  James A. White,et al.  Bicuspid aortic valve disease is associated with abnormal wall shear stress, viscous energy loss, and pressure drop within the ascending thoracic aorta , 2021, Medicine.

[5]  M. Nagao,et al.  Circulation derived from 4D flow MRI correlates with right ventricular dysfunction in patients with tetralogy of Fallot , 2021, Scientific Reports.

[6]  K. Hollingsworth,et al.  A 4D flow cardiovascular magnetic resonance study of flow asymmetry and haemodynamic quantity correlations in the pulmonary artery , 2021, Physiological measurement.

[7]  J. White,et al.  Aortic and mitral flow quantification using dynamic valve tracking and machine learning: Prospective study assessing static and dynamic plane repeatability, variability and agreement , 2021, JRSM cardiovascular disease.

[8]  E. V. Valsangiacomo Buechel,et al.  Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children , 2020, Pediatric Radiology.

[9]  Yong Zhang,et al.  Pulmonary artery hemodynamic assessment of blood flow characteristics in repaired tetralogy of Fallot patients versus healthy child volunteers. , 2020, Quantitative imaging in medicine and surgery.

[10]  E. Nagel,et al.  Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update , 2020, Journal of Cardiovascular Magnetic Resonance.

[11]  A. Barker,et al.  Increased systolic vorticity in the left ventricular outflow tract is associated with abnormal aortic flow formations in Tetralogy of Fallot , 2020, The International Journal of Cardiovascular Imaging.

[12]  T. Leiner,et al.  Three-dimensional and four-dimensional flow assessment in congenital heart disease , 2019, Heart.

[13]  James A White,et al.  Pressure drop mapping using 4D flow MRI in patients with bicuspid aortic valve disease: A novel marker of valvular obstruction. , 2019, Magnetic resonance imaging.

[14]  A. Marsden,et al.  Intracardiac 4D Flow MRI in Congenital Heart Disease: Recommendations on Behalf of the ISMRM Flow & Motion Study Group , 2019, Journal of magnetic resonance imaging : JMRI.

[15]  M. Markl,et al.  The Role of Imaging of Flow Patterns by 4D Flow MRI in Aortic Stenosis. , 2019, JACC. Cardiovascular imaging.

[16]  M. Markl,et al.  4-D flow magnetic-resonance-imaging-derived energetic biomarkers are abnormal in children with repaired tetralogy of Fallot and associated with disease severity , 2018, Pediatric Radiology.

[17]  A. Kheradvar,et al.  Simplified Bernoulli's method significantly underestimates pulmonary transvalvular pressure drop , 2016, Journal of magnetic resonance imaging : JMRI.

[18]  Alex J. Barker,et al.  Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI , 2016, European Radiology.

[19]  M. Markl,et al.  4D flow cardiovascular magnetic resonance consensus statement , 2015, Journal of Cardiovascular Magnetic Resonance.

[20]  O. Wieben,et al.  Ventricular kinetic energy may provide a novel noninvasive way to assess ventricular performance in patients with repaired tetralogy of Fallot. , 2015, The Journal of thoracic and cardiovascular surgery.

[21]  Dimitris Rizopoulos,et al.  Unnatural History of Tetralogy of Fallot: Prospective Follow-Up of 40 Years After Surgical Correction , 2014, Circulation.

[22]  Michael Markl,et al.  Viscous energy loss in the presence of abnormal aortic flow , 2014, Magnetic resonance in medicine.

[23]  Bradley D. Allen,et al.  4D flow imaging with MRI. , 2014, Cardiovascular diagnosis and therapy.

[24]  Xiao Liu,et al.  Physiological Significance of Helical Flow in the Arterial System and its Potential Clinical Applications , 2014, Annals of Biomedical Engineering.

[25]  Jeffrey A. Feinstein,et al.  Hot topics in tetralogy of Fallot. , 2013, Journal of the American College of Cardiology.

[26]  Scott B Reeder,et al.  4D cardiovascular magnetic resonance velocity mapping of alterations of right heart flow patterns and main pulmonary artery hemodynamics in tetralogy of Fallot , 2012, Journal of Cardiovascular Magnetic Resonance.

[27]  Jeroen J. Bax,et al.  Tetralogy of fallot: 3D velocity-encoded MR imaging for evaluation of right ventricular valve flow and diastolic function in patients after correction. , 2010, Radiology.

[28]  Tal Geva,et al.  Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography , 2008, The International Journal of Cardiovascular Imaging.

[29]  S. Siu,et al.  Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study , 2000, The Lancet.