Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects

作者：Calkoen Emmeline E; Elbaz Mohammed S M; Westenberg Jos J M; Kroft Lucia J M; Hazekamp Mark G; Roest Arno A W^*; van der Geest Rob J

来源：The Journal of Thoracic and Cardiovascular Surgery, 2015, 150(5): 1233-+.

DOI：10.1016/j.jtcvs.2015.07.048

• atrioventricular septal defect
• atrioventricular valves
• vortex flow
• 4D flow MRI

Objectives: During normal left ventricular (LV) filling, a vortex ring structure is formed distal to the left atrioventricular valve (LAVV). Vortex structures contribute to efficient flow organization. We aimed to investigate whether LAVV abnormality in patients with a corrected atrioventricular septal defect (AVSD) has an impact on vortex ring formation.
Methods: Whole-heart 4D flow MRI was performed in 32 patients (age: 26 +/- 12 years), and 30 healthy subjects (age: 25 +/- 14 years). Vortex ring cores were detected at peak early (E-peak) and peak late filling (A-peak). When present, the 3-dimensional position and orientation of the vortex ring was defined, and the circularity index was calculated. Through-plane flow over the LAVV, and the vortex formation time (VFT), were quantified to analyze the relationship of vortex flow with the inflow jet.
Results: Absence of a vortex ring during E-peak (healthy subjects 0%, vs patients 19%; P = .015), and A-peak (healthy subjects 10% vs patients 44%; P = .008) was more frequent in patients. In 4 patients, this was accompanied by a high VFT (5.1-7.8 vs 2.4 +/- 0.6 in healthy subjects), and in another 2 patients with abnormal valve anatomy. In patients compared with controls, the vortex cores had a more-anterior and apical position, closer to the ventricular wall, with a more-elliptical shape and oblique orientation. The shape of the vortex core closely resembled the valve shape, and its orientation was related to the LV inflow direction.
Conclusions: This study quantitatively shows the influence of abnormal LAVV and LV inflow on 3D vortex ring formation during LV inflow in patients with corrected AVSD, compared with healthy subjects.

• 出版日期2015-11