In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

Shiva Sharma; Ann E. Ensley; Katharine Hopkins; George P. Chatzimavroudis; Timothy M. Healy; Vincent K.H. Tam; Kirk R. Kanter; Ajit P. Yoganathan

doi:10.1016/S0003-4975(00)02517-0

In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

Shiva Sharma, Ann E. Ensley, Katharine Hopkins, George P. Chatzimavroudis, Timothy M. Healy, Vincent K.H. Tam, Kirk R. Kanter, Ajit P. Yoganathan

Research output: Contribution to journal › Article › peer-review

42 Scopus citations

Abstract

Background. The total cavopulmonary connection (TCPC) design continues to be refined on the basis of flow analysis at the connection site. These refinements are of importance for myocardial energy conservation in the univentricular supported circulation. In vivo magnetic resonance phase contrast imaging provides semiquantitative flow visualization information. The purpose of this study was to understand the in vivo TCPC flow characteristics obtained by magnetic resonance phase contrast imaging and compare the results with our previous in vitro TCPC flow experiments in an effort to further refine TCPC surgical design. Methods. Twelve patients with TCPC underwent sedated three-dimensional, multislice magnetic resonance phase contrast imaging. Seven patients had intraatrial lateral tunnel TCPC and 5 had extracardiac TCPC. Results. In all patients in both groups a disordered flow pattern was observed in the inferior caval portion of the TCPC. Flow at the TCPC site appeared to be determined by connection geometry, being streamlined at the superior vena cava-pulmonary junction when the superior vena cava was offset and flared toward the left pulmonary artery. Without caval offset, intense swirling and dominance of superior vena caval flow was observed. In TCPC with bilateral superior vena cavae, the flow patterns observed included secondary vortices, a central stagnation point, and influx of the superior vena cava flow into the inferior caval conduit. A comparative analysis of in vivo flow and our previous in vitro flow data from glass model prototypes of TCPC demonstrated significant similarities in flow disturbances. Three-dimensional magnetic resonance phase contrast imaging in multiple Coronal planes enabled a comprehensive semiquantitative flow analysis. The data are presented in traditional instantaneous images and in animated format for interactive display of the flow dynamics. Conclusions. Flow in the inferior caval portion of the TCPC is disordered, and the TCPC geometry determines flow characteristics.

Original language	English (US)
Pages (from-to)	889-898
Number of pages	10
Journal	Annals of Thoracic Surgery
Volume	71
Issue number	3
DOIs	https://doi.org/10.1016/S0003-4975(00)02517-0
State	Published - 2001
Externally published	Yes

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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10.1016/S0003-4975(00)02517-0

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@article{6eefe40e8ab24cdf84953bb15502e031,

title = "In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging",

abstract = "Background. The total cavopulmonary connection (TCPC) design continues to be refined on the basis of flow analysis at the connection site. These refinements are of importance for myocardial energy conservation in the univentricular supported circulation. In vivo magnetic resonance phase contrast imaging provides semiquantitative flow visualization information. The purpose of this study was to understand the in vivo TCPC flow characteristics obtained by magnetic resonance phase contrast imaging and compare the results with our previous in vitro TCPC flow experiments in an effort to further refine TCPC surgical design. Methods. Twelve patients with TCPC underwent sedated three-dimensional, multislice magnetic resonance phase contrast imaging. Seven patients had intraatrial lateral tunnel TCPC and 5 had extracardiac TCPC. Results. In all patients in both groups a disordered flow pattern was observed in the inferior caval portion of the TCPC. Flow at the TCPC site appeared to be determined by connection geometry, being streamlined at the superior vena cava-pulmonary junction when the superior vena cava was offset and flared toward the left pulmonary artery. Without caval offset, intense swirling and dominance of superior vena caval flow was observed. In TCPC with bilateral superior vena cavae, the flow patterns observed included secondary vortices, a central stagnation point, and influx of the superior vena cava flow into the inferior caval conduit. A comparative analysis of in vivo flow and our previous in vitro flow data from glass model prototypes of TCPC demonstrated significant similarities in flow disturbances. Three-dimensional magnetic resonance phase contrast imaging in multiple Coronal planes enabled a comprehensive semiquantitative flow analysis. The data are presented in traditional instantaneous images and in animated format for interactive display of the flow dynamics. Conclusions. Flow in the inferior caval portion of the TCPC is disordered, and the TCPC geometry determines flow characteristics.",

author = "Shiva Sharma and Ensley, {Ann E.} and Katharine Hopkins and Chatzimavroudis, {George P.} and Healy, {Timothy M.} and Tam, {Vincent K.H.} and Kanter, {Kirk R.} and Yoganathan, {Ajit P.}",

note = "Funding Information: From 20 patients who underwent magnetic resonance scans, 12 patients had complete studies and form the study group. In 8 of 20 patients, studies were excluded for movement artifact due to patient awakening [3] , artifact from coils in systemic pulmonary collaterals [1] , insufficient scan time [3] , and a technical masking error [1] . The study protocol was approved by the Institutional Review Board of Emory University School of Medicine and informed consent was obtained from parents. The studies were fully funded by American Heart Association (Georgia Affiliate) Grant for the study period from July 1996 to July 1999. ",

year = "2001",

doi = "10.1016/S0003-4975(00)02517-0",

language = "English (US)",

volume = "71",

pages = "889--898",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier USA",

number = "3",

}

TY - JOUR

T1 - In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

AU - Sharma, Shiva

AU - Ensley, Ann E.

AU - Hopkins, Katharine

AU - Chatzimavroudis, George P.

AU - Healy, Timothy M.

AU - Tam, Vincent K.H.

AU - Kanter, Kirk R.

AU - Yoganathan, Ajit P.

N1 - Funding Information: From 20 patients who underwent magnetic resonance scans, 12 patients had complete studies and form the study group. In 8 of 20 patients, studies were excluded for movement artifact due to patient awakening [3] , artifact from coils in systemic pulmonary collaterals [1] , insufficient scan time [3] , and a technical masking error [1] . The study protocol was approved by the Institutional Review Board of Emory University School of Medicine and informed consent was obtained from parents. The studies were fully funded by American Heart Association (Georgia Affiliate) Grant for the study period from July 1996 to July 1999.

PY - 2001

Y1 - 2001

N2 - Background. The total cavopulmonary connection (TCPC) design continues to be refined on the basis of flow analysis at the connection site. These refinements are of importance for myocardial energy conservation in the univentricular supported circulation. In vivo magnetic resonance phase contrast imaging provides semiquantitative flow visualization information. The purpose of this study was to understand the in vivo TCPC flow characteristics obtained by magnetic resonance phase contrast imaging and compare the results with our previous in vitro TCPC flow experiments in an effort to further refine TCPC surgical design. Methods. Twelve patients with TCPC underwent sedated three-dimensional, multislice magnetic resonance phase contrast imaging. Seven patients had intraatrial lateral tunnel TCPC and 5 had extracardiac TCPC. Results. In all patients in both groups a disordered flow pattern was observed in the inferior caval portion of the TCPC. Flow at the TCPC site appeared to be determined by connection geometry, being streamlined at the superior vena cava-pulmonary junction when the superior vena cava was offset and flared toward the left pulmonary artery. Without caval offset, intense swirling and dominance of superior vena caval flow was observed. In TCPC with bilateral superior vena cavae, the flow patterns observed included secondary vortices, a central stagnation point, and influx of the superior vena cava flow into the inferior caval conduit. A comparative analysis of in vivo flow and our previous in vitro flow data from glass model prototypes of TCPC demonstrated significant similarities in flow disturbances. Three-dimensional magnetic resonance phase contrast imaging in multiple Coronal planes enabled a comprehensive semiquantitative flow analysis. The data are presented in traditional instantaneous images and in animated format for interactive display of the flow dynamics. Conclusions. Flow in the inferior caval portion of the TCPC is disordered, and the TCPC geometry determines flow characteristics.

AB - Background. The total cavopulmonary connection (TCPC) design continues to be refined on the basis of flow analysis at the connection site. These refinements are of importance for myocardial energy conservation in the univentricular supported circulation. In vivo magnetic resonance phase contrast imaging provides semiquantitative flow visualization information. The purpose of this study was to understand the in vivo TCPC flow characteristics obtained by magnetic resonance phase contrast imaging and compare the results with our previous in vitro TCPC flow experiments in an effort to further refine TCPC surgical design. Methods. Twelve patients with TCPC underwent sedated three-dimensional, multislice magnetic resonance phase contrast imaging. Seven patients had intraatrial lateral tunnel TCPC and 5 had extracardiac TCPC. Results. In all patients in both groups a disordered flow pattern was observed in the inferior caval portion of the TCPC. Flow at the TCPC site appeared to be determined by connection geometry, being streamlined at the superior vena cava-pulmonary junction when the superior vena cava was offset and flared toward the left pulmonary artery. Without caval offset, intense swirling and dominance of superior vena caval flow was observed. In TCPC with bilateral superior vena cavae, the flow patterns observed included secondary vortices, a central stagnation point, and influx of the superior vena cava flow into the inferior caval conduit. A comparative analysis of in vivo flow and our previous in vitro flow data from glass model prototypes of TCPC demonstrated significant similarities in flow disturbances. Three-dimensional magnetic resonance phase contrast imaging in multiple Coronal planes enabled a comprehensive semiquantitative flow analysis. The data are presented in traditional instantaneous images and in animated format for interactive display of the flow dynamics. Conclusions. Flow in the inferior caval portion of the TCPC is disordered, and the TCPC geometry determines flow characteristics.

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U2 - 10.1016/S0003-4975(00)02517-0

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JF - Annals of Thoracic Surgery

IS - 3

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In vivo flow dynamics of the total cavopulmonary connection from three-dimensional multislice magnetic resonance imaging

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